Method and apparatus for optimizing cardiac resynchronization therapy based on left ventricular acceleration
First Claim
1. A method for assessing left ventricular function and optimizing cardiac pacing intervals in a device programmed to operate a bi-ventricular cardiac pacing modality, comprising:
- disposing a transducer that is adapted to directly sense movement of a portion of a left ventricular chamber of a heart and providing a signal related to the movement;
coupling said signal to a means for detecting the movement;
iteratively adjusting an interventricular (V—
V) timing parameter of a first pacing electrode in electrical communication with one ventricle relative to a second pacing electrode in electrical communication with the other ventricle over a range of temporal values;
for each of at least two of the interventricular (V—
V) timing parameters, storing the interventricular (V—
V) timing parameter and the peak amplitude value corresponding to a first peak of the signal obtained during an isovolumetric contraction portion of a cardiac cycle;
comparing the magnitude of the stored peak amplitude values; and
programming an optimized interventricular (V—
V) interval using the interventricular (V—
V) timing parameter corresponding to the highest stored peak amplitude value.
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Accused Products
Abstract
A system and method for monitoring left ventricular cardiac contractility and for optimizing a cardiac therapy based on left ventricular lateral wall acceleration (LVA) are provided. The system includes an implantable or external cardiac stimulation device in association with a set of leads including a left ventricular epicardial or coronary sinus lead equipped with an acceleration sensor. The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of LVA during isovolumic contraction. A therapy optimization method evaluates the LVA during varying therapy settings and selects the setting(s) that correspond to a maximum LVA during isovolumic contraction. In one embodiment, the optimal inter-ventricular pacing interval for use in cardiac resynchronization therapy is determined as the interval corresponding to the highest amplitude of the first LVA peak during isovolumic contraction.
277 Citations
35 Claims
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1. A method for assessing left ventricular function and optimizing cardiac pacing intervals in a device programmed to operate a bi-ventricular cardiac pacing modality, comprising:
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disposing a transducer that is adapted to directly sense movement of a portion of a left ventricular chamber of a heart and providing a signal related to the movement;
coupling said signal to a means for detecting the movement;
iteratively adjusting an interventricular (V—
V) timing parameter of a first pacing electrode in electrical communication with one ventricle relative to a second pacing electrode in electrical communication with the other ventricle over a range of temporal values;
for each of at least two of the interventricular (V—
V) timing parameters, storing the interventricular (V—
V) timing parameter and the peak amplitude value corresponding to a first peak of the signal obtained during an isovolumetric contraction portion of a cardiac cycle;
comparing the magnitude of the stored peak amplitude values; and
programming an optimized interventricular (V—
V) interval using the interventricular (V—
V) timing parameter corresponding to the highest stored peak amplitude value. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A computer readable medium programmed with instructions for performing a method for assessing left ventricular function and optimizing cardiac pacing intervals in a device programmed to operate a bi-ventricular cardiac pacing modality, comprising:
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instructions for sensing movement of a portion of a left ventricular chamber of a heart with a deployed movement transducer and for measuring a signal from the transducer related to the movement;
instructions for iteratively adjusting an interventricular (V—
V) timing parameter of a first pacing electrode in electrical communication with one ventricle relative to a second pacing electrode in electrical communication with the other ventricle over a range of temporal values;
instructions for storing at least two of the interventricular (V—
V) timing parameters and, for each of at least two of the interventricular (V—
V) timing parameters, instructions for relating each stored interventricular (V—
V) timing parameters to a peak amplitude value corresponding to a first peak of the signal obtained during an isovolumetric contraction portion of a cardiac cycle;
instructions for comparing the magnitude of the stored peak amplitude values; and
instruction for programming an optimized interventricular (V—
V) interval using the interventricular (V—
V) timing parameter corresponding to the highest stored peak amplitude value. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27)
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28. An apparatus for optimizing interventricular (V—
- V) synchrony and as a result of such optimization delivering closed-loop cardiac resynchronization therapy, comprising;
a transducer means for measuring movement of a portion of the lateral wall of a left ventricle and providing a movement signal related to such movement and coupled to a movement measurement circuit that is coupled to a pulse generator;
a left pacing electrode in electrical communication with a portion of the left ventricle and electrically coupled to a pacing circuit of the pulse generator;
a right pacing electrode in electrical communication with a portion of a right ventricle and electrically coupled to the pacing circuit of the pulse generator; and
interventricular (V—
V) interval optimization means for iteratively changing a interventricular (V—
V) interval for at least one cardiac cycle and storing a peak amplitude value corresponding to a first peak of the movement signal obtained during an isovolumetric contraction portion of a cardiac cycle in relation to the interventricular (V—
V) interval used during the cardiac cycle, and for comparing the stored peak amplitudes and then programming an optimized interventricular (V—
V) interval based on the interventricular (V—
V) interval corresponding to the greatest peak amplitude. - View Dependent Claims (29, 30, 31, 32, 33, 34, 35)
- V) synchrony and as a result of such optimization delivering closed-loop cardiac resynchronization therapy, comprising;
Specification