Methods and systems for treating patients with congestive heart failure (CHF)

• US 6,751,503 B1
• Filed: 11/01/2001
• Issued: 06/15/2004
• Est. Priority Date: 11/01/2001
• Status: Expired due to Term

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Kroll, Mark W.
• Primary Examiner(s): LAYNO, CARL HERNANDZ
• Application Number:
  US09/999,408
• Time in Patent Office: 957 Days
• Field of Search: 607/9, 607/17, 607/18, 607/25
• US Class Current: 607/18
• 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 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium

Abstract

Various embodiments provide techniques and systems that can ensure that patients with congestive heart failure receive pacing therapy that optimizes their hemodynamic performance in view of various variables that pertain to the patient. Exemplary variables can include, without limitation, the time of day, patient posture and activity level.

Claims

1. A method comprising:

monitoring multiple different variables associated with a patient having congestive heart failure (CHF), the variables comprising time of day, patient activity level, and posture;

for a given set of variable values, selecting one or more timing parameters that can be used to administer pacing therapy to the patient to improve hemodynamic performance; and

administering pacing therapy using the selected timing parameters.

2. The method of claim 1, wherein said selecting comprises selecting parameters associated with A-V timing.

3. The method of claim 1, wherein said selecting comprises selecting parameters associated with timing between left and right ventricles (V-V timing).

4. The method of claim 1, wherein said selecting comprises selecting parameters associated with A-V and timing between left and right ventricles (V-V timing).

5. The method of claim 1, wherein said selecting comprises selecting parameters effective to optimize a patient'"'"'s hemodynamic performance.

6. A stimulation device composing:

one or more processors;

memory;

computer-readable instructions in the memory which, when executed by the one or more processors, cause the processors to;

monitor multiple different variables associated with a patient having congestive heart failure (CHF), the variables comprising time of day, patient activity level, and posture;

for a given set of variable values, select one or more timing parameters that can be used to administer pacing therapy to the patient to improve hemodynamic performance; and

administer pacing therapy using the selected timing parameters.

7. The stimulation device of claim 6, wherein the instructions cause the one or more processors to select parameters associated with A-V timing.

8. The stimulation device of claim 6, wherein the instructions cause the one or more processors to select parameters associated with timing between left and right ventricles (V-V timing).

9. The stimulation device of claim 6, wherein the instructions cause the one or more processors to select parameters associated with A-V timing and timing between left and right ventricles (V-V timing).

10. One or more computer-readable media having instructions thereon which, when executed by an implantable stimulation device, cause the stimulation device to:

monitor multiple different variables associated with a patient having congestive heart failure (CHF), the variables comprising time of day, patient activity level, and posture;

for a given set of variable values, select one or more timing parameters that can be used to administer pacing therapy to the patient effective to optimize a patient'"'"'s hemodynamic performance; and

administer pacing therapy using the selected timing parameters.

11. The computer-readable media of claim 10, wherein the instructions cause the stimulation device to select parameters associated with A-V timing.

12. The computer-readable media of claim 10 wherein the instructions cause the stimulation device to select parameters associated with timing between left and right ventricles (V-V timing).

13. The computer-readable media of claim 10, wherein the instructions cause the stimulation device to select parameters associated with A-V and V-V timing.

14. A method comprising:

monitoring multiple different variables associated with a patient having congestive heart failure (CHF), the variables being independent of the patient'"'"'s heart function;

for a given set of variable values, determining whether one or more timing parameters exist that can be used to administer pacing therapy to the patient to optimize the patients hemodynamic performance;

in an event that one or more timing parameters do exist for the given set of variable values, administering pacing therapy to the patent using the existing timing parameters; and

in an event that one or more timing parameters do not exist for the given set of variable values, automatically determining timing parameters that optimize the patient'"'"'s hemodynamic performance for the given set of variables.

15. The method of claim 14 further comprising administering pacing therapy to the patient using the determined timing parameters.

16. The method of claim 14 further comprising storing the determined timing parameters for future use.

17. The method of claim 14, wherein said automatically determining the timing parameters comprises determining parameters associated with A-V timing.

18. The method of claim 14, wherein said automatically determining the timing parameters comprises determining parameters associated with timing between left and right ventricles (V-V timing).

19. The method of claim 14, wherein said automatically determining the timing parameters comprises determining parameters associated with A-V timing and timing between left and right ventricles (V-V timing).

20. The method of claim 14, wherein one of said variables comprises a time of day variable.

21. The method of claim 14, wherein one of said variables comprises a patient activity level variable.

22. The method of claim 14, wherein one of said variables comprises a patient posture variable.

23. The method of claim 14, wherein said variables comprise one or more of a time of day variable, a patient activity level variable, and a patient posture variable.

24. The method of claim 14, wherein said automatically determining comprises doing so through trial and error techniques.

25. A stimulation device comprising:

one or more processors;

memory;

computer-readable instructions in the memory which, when executed by the one or more processors, cause the processors to;

monitor multiple different variables associated with a patient having congestive heart failure (CHF), the variables being independent of the patient'"'"'s heart function;

for a given set of variable values, determine whether one or more timing parameters exist that can be used to administer pacing therapy to the patient to optimize the patient'"'"'s hemodynamic performance;

in an event that one or more timing parameters do exist for the given set of variable values, administer pacing therapy to the patient using the existing timing parameters;

in an event that one or more timing parameters do not exist for the given set of variable values, automatically determine timing parameters that optimize the patient'"'"'s hemodynamic performance for the given set of variables; and

administer pacing therapy to the patient using the determined timing parameters.

26. The stimulation device of claim 25, wherein the instructions cause the stimulation device to store the determined timing parameters for future use.

27. The stimulation device of claim 25, wherein the instructions cause the stimulation device to automatically determine parameters associated with A-V timing.

28. The stimulation device of claim 25, wherein the instructions cause the stimulation device to automatically determine parameters associated with timing between left and right ventricles (V-V timing).

29. The stimulation device of claim 25, wherein the instructions cause the stimulation device to automatically determine parameters associated with A-V timing and timing between left and right ventricles (V-V timing).

30. The stimulation device of claim 25, wherein one of said variables comprises a time of day variable.

31. The stimulation device of claim 25, wherein one of said variables comprises a patient posture variable.

32. The stimulation device of claim 25, wherein one of said variables comprises a patient activity level variable.

33. The stimulation device of claim 25, wherein said variables comprise one or more of a time of day variable, a patient posture variable, and a patient activity level variable.

34. A method comprising:

monitoring multiple different variables associated with a patient having congestive heart failure (CHF), the variables being independent of the patient'"'"'s heart function;

for a given set of variable values, determining whether one or more timing parameters exist that can be used to administer pacing therapy to the patient to optimize the patient'"'"'s hemodynamic performance;

in an event that one or more timing parameters do not exist for the given set of variable values, automatically determining timing parameters that optimize the patient'"'"'s hemodynamic performance for the given set of variables by using one or more optimization techniques; and

administering pacing therapy using the determined timing parameters.

35. The method of claim 34, wherein said optimization techniques comprise a simplex optimization technique.

36. The method of claim 34, wherein said optimization techniques comprise a steepest descent optimization method.

37. The method of claim 34, wherein said optimization techniques comprise one or more of a simplex optimization technique and a steepest descent optimization method.

38. A method comprising:

defining one or more surfaces that describe optimal timing parameters for pacing a patient with congestive heart failure (CHF), the surfaces being defined as a function of patient posture, time of day, and activity level;

determining a patient'"'"'s posture, the time of day, and the activity level of the patient;

finding a point on the one or more surfaces that correspond to the patient'"'"'s posture, the time of day, and the activity level; and

pacing the patient using timing parameters that correspond to said point on the one or more surfaces.

39. The method of claim 38, wherein said timing parameters pertain to A-V timing.

40. The method of claim 38, wherein said timing parameters pertain to timing between left and right ventricles (V-V timing).

41. The method of claim 38, wherein said timing parameters to A-V timing and timing between left and right ventricles (V-V timing).

42. An implantable stimulation device comprising:

one or more processors;

memory;

computer-readable instructions in the memory which, when executed by the one or more processors, cause the processors to;

define one or more surfaces that describe optimal timing parameters for pacing a patient with congestive heart failure (CHF), the surfaces being defined as a function of patient posture, time of day, and activity level;

determine a patient'"'"'s posture, the time of day, and the activity level of the patient;

find a point on the one or more surfaces that correspond to the patient'"'"'s posture, the time of day, and the activity level; and

pace the patient using timing parameters that correspond to said point on the one or more surfaces.