Method and apparatus for optimizing cardiac resynchronization therapy

• US 6,871,088 B2
• Filed: 03/20/2003
• Issued: 03/22/2005
• Est. Priority Date: 03/20/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Chinchoy, Edward
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US10/394,777
• Publication Number:
  US 20040186524A1
• Time in Patent Office: 733 Days
• Field of Search: 600/485, 600/490, 600/500, 600/503, 600/508, 600/510, 600/486, 600/509, 600/519, 600/526
• US Class Current: 600/510
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• 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 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A method and apparatus for optimizing cardiac resynchronization therapy are provided. An iterative optimization procedure is performed to test the systolic hemodynamic effects of varying A-V-V timing schemes. The hemodynamic effect is assessed based on a surrogate of stroke volume. The stroke volume surrogate is derived from a sensor signal proportional to the blood pressure in the aorta or a major artery. The A-V-V timing scheme corresponding to the greatest stroke volume, as indicated by the stroke volume surrogate, is identified and automatically programmed to maintain optimal A-V-V settings acutely and chronically.

Claims

1. A method for optimizing cardiac resynchronization therapy comprising:

a. sensing a signal proportional to a blood pressure present in an aorta or a major artery of a patient;

b. determining a stroke volume surrogate from the sensed signal proportional to blood pressure by deriving a signal characteristic that varies proportionally to stroke volume variations;

c. at least temporarily storing in a computer readable storage medium at least a one of the following;

the signal, the stroke volume surrogate, the signal characteristic

d. applying a number of A-V-V timing schemes and repeating steps a., b., and c. for each of said number of A-V-V timing schemes; and

e. identifying an optimal A-V-V timing scheme corresponding to the greatest stroke volume based on the stroke volume surrogate for at least two of said number of A-V-V timing schemes.

2. A computer readable medium for storing instructions for performing the following method, comprising:

a. instructions for sensing a signal proportional to a blood pressure present in an aorta or a major artery of a patient;

b. instructions for determining a stroke volume surrogate from the sensed signal proportional to blood pressure by deriving a signal characteristic that varies proportionally to stroke volume variations;

c. instructions for at least temporarily storing in a computer readable storage medium at least a one of the following;

the signal, the stroke volume surrogate, the signal characteristic

d. instructions for applying a number of A-V-V timing schemes and repeating steps a., b., and c. for each of said number of A-V-V timing schemes; and

e. instructions for identifying an optimal A-V-V timing scheme corresponding to the greatest stroke volume based on the stroke volume surrogate for at least two of said number of A-V-V timing schemes.

3. An apparatus for optimizing cardiac resynchronization therapy comprising

a. means for sensing a signal proportional to a blood pressure present in an aorta or a major artery of a patient;

b. means for determining a stroke volume surrogate from the sensed signal proportional to blood pressure by deriving a signal characteristic that varies proportionally to stroke volume variations;

c. means for, at least temporarily, storing in a computer readable storage medium at least a one of the following;

the signal, the stroke volume surrogate, the signal characteristic

d. means for applying a number of A-V-V timing schemes and repeating steps a., b., and c. for each of said number of A-V-V timing schemes; and

e. means for identifying an optimal A-V-V timing scheme corresponding to the greatest stroke volume based on the stroke volume surrogate for at least two of said number of A-V-V timing schemes.