Method of pacing a heart using implantable device

• US 6,915,149 B2
• Filed: 01/11/2002
• Issued: 07/05/2005
• Est. Priority Date: 01/08/1996
• Status: Expired due to Fees

• Current Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Original Assignee: Biosense, Inc. (Cardinal Health, Inc.)
• Inventors: Ben-Haim, Shlomo
• Primary Examiner(s): Cohen, Lee S.
• Application Number:
  US10/043,663
• Publication Number:
  US 20020087089A1
• Time in Patent Office: 1,271 Days
• Field of Search: 600/374, 600/508, 600/509, 607/9, 607/122
• US Class Current: 600/374
• CPC Class Codes: A61B 18/20 using laser
• CPC Class Codes: A61B 2017/00247 Making holes in the wall of the heart, e.g. laser Myocardial revascularization
• CPC Class Codes: A61B 2018/00392 Transmyocardial revascularisation
• CPC Class Codes: A61B 5/02014 Determining aneurysm
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/06 Devices, other than using radiation, for detecting or locating foreign bodies for removing same A61B17/50 ; determining position of probes within or on the body of the patient
• CPC Class Codes: A61B 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/6843 Monitoring or controlling sensor contact pressure
• CPC Class Codes: A61B 5/6859 with multiple distal splines
• CPC Class Codes: A61M 2025/0166 Sensors, electrodes or the like for guiding the catheter to a target zone, e.g. image guided or magnetically guided
• CPC Class Codes: A61N 1/32 alternating or intermittent currents applying electric fields by inductive or capacitive coupling A61N1/40; microwave apparatus A61N5/02
• 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

Abstract

A method of determining an optimal location for implanting a pacemaker electrode includes the steps of pacing a heart from a first location and generating a first map of the heart associated with pacing at the first location. The heart is paced from a second location and a second map is generated of the heart associated with pacing at the second location. The first and second maps are compared in order to diagnose the effect of the pacing and an optimal location for implanting the pacemaker electrode based on the comparison of the maps is selected.

Claims

1. A method of determining an optimal location for implanting a pacemaker electrode comprising:

pacing a heart from a first location;

generating a first map of the heart associated with pacing at the first location;

pacing the heart from a second location;

generating a second map of the heart associated with pacing at the second location;

comparing the first and second maps to diagnose the effect of the pacing; and

selecting an optimal location for implanting the pacemaker electrode based on comparing the maps.

2. A method according to claim 1, wherein generating the first map comprises:

(a) bringing an invasive probe into contact with a site on the wall of the heart;

(b) determining a position of the invasive probe;

(c) determining a cardiac characteristic at the site;

(d) repeating (a)-(c) for a plurality of sites of the heart; and

(e) combining the positions to form a time-dependent map of at least a portion of the heart.

3. A method according to claim 2, wherein determining the position comprises determining the position at least two different phases of a heart cycle of the heart.

4. A method according to claim 2, wherein determining the cardiac characteristic at the site comprises determining an electrical value at the site.

5. A method according to claim 2, wherein determining the cardiac characteristic at the site comprises determining a non-electrical physiological value at the site.

6. A method according to claim 1, wherein generating the first map comprises:

(a) bringing an invasive probe into contact with a site on the wall of the heart;

(b) determining a position of the invasive probe;

(c) determining a cardiac characteristic at the site;

(d) repeating (a)-(c) for a plurality of sites of the heart; and

(e) combining the positions to form a map of at least a portion of the heart.

7. A method according to claim 6, wherein determining the cardiac characteristic comprises determining the cardiac characteristic at the site at a plurality of different phases of the heart cycle.

8. A method according to claim 6, wherein determining the cardiac characteristic at the site comprises determining a non-electrical physiological value at the site.

9. A method according to claim 6, wherein determining the cardiac characteristic at the site comprises determining an electrical value at the site.

10. A method according to claim 6, comprising determining at least a second position of the invasive probe, which position is different from the position determined in (b).

11. A method according to claim 10, comprising determining at least one local relationship between changes in positions of the invasive probe and a determined local cardiac characteristic.

12. A method according to claim 6, wherein the cardiac characteristic is determined using a sensor external to the probe.

13. A method according to claim 12, wherein the sensor is external to a body which comprises the heart.

14. A method according to claim 6, wherein the cardiac characteristic is determined using a sensor in the invasive probe.

15. A method according to claim 6, wherein the cardiac characteristic is determined at substantially the same time as the position of the invasive probe.

16. A method according to claim 6, wherein the cardiac characteristic comprises a thickness of the heart at the site.

17. A method according to claim 16, wherein the thickness of the heart is determined using an ultrasonic transducer mounted on the invasive probe.

18. A method according to claim 16, comprising determining a reaction of the heart to an activation signal by analyzing changes in the thickness of the heart.

19. A method according to claim 6, wherein the cardiac characteristic comprises a measure of a perfusion at the site.

20. A method according to any claim 6, wherein the cardiac characteristic comprises a measure of work performed at the site.

21. A method according to claim 6, comprising determining a local electrical activity at each of the plurality of sites of the heart.

22. A method according to claim 21, wherein the electrical activity comprises a local electrogram.

23. A method according to claim 21, wherein the electrical activity comprises a local activation time.

24. A method according to claim 21, wherein the electrical activity is determined as a local plateau duration at each of the plurality of sites of the heart.

25. A method according to claim 21, wherein the electrical activity comprises a peak-to-peak value of a local electrogram.

26. A method according to claim 1, wherein comparing the maps comprises analyzing the maps to determine underutilized portions of the heart.

27. A method according to claim 1, wherein comparing the maps comprises analyzing the maps to determine over-stressed portions of the heart.

28. A method according to claim 1, wherein selecting the optimal location comprises:

choosing a portion of the heart having a certain amount of muscle tissue thereat; and

determining a pacing regime for changing the workload of the portion.

29. A method according to claim 28, comprising pacing the heart using the determined pacing regime.

30. A method according to claim 29, comprising:

waiting a period of time;

then determining the effect of the pacing regime; and

repeating choosing, determining and pacing the heart using the determined pacing regime if a desired effect is not reached.

31. A method according to claim 30, wherein waiting the period of time comprises waiting at least one week.

32. A method according to claim 28, wherein the workload of the portion is increased in order to increase the amount of muscle tissue therein.

33. A method according to claims 28, wherein the workload of the portion is decreased in order to decrease the amount of muscle tissue thereat.

34. A method according to claim 28, wherein the workload is changed by changing an activation time of the portion.

35. A method according to claim 28, wherein the map includes electrical activation information.

36. A method according to claim 28, wherein the map includes mechanical activation information.

37. A method according to claim 1 comprising determining a cardiac parameter associated with pacing at the first and second locations, and implanting the electrode at the location for which the cardiac parameter is optimal.

38. A method according to claim 1, wherein pacing the heart from the first location comprises bringing an invasive probe having an electrode to the first location and electrifying the electrode with a pacing current.

39. A method according to claim 37, wherein determining the cardiac parameter comprises determining stroke volume.

40. A method according to claim 37, wherein determining the cardiac parameter comprises determining intra-cardiac pressure.

41. A method according to claim 37, wherein determining the cardiac parameter comprises measuring the cardiac parameter using an invasive probe.

42. A method according to claim 1, wherein generating the first map comprises determining a local physiological value at a plurality of sites in the heart.

43. A method according to claim 42, comprising:

determining a pacing regime which changes a distribution of the physiological values in a desired manner.

44. A method according to claim 43, wherein the distribution of the physiological values comprises a temporal distribution.

45. A method according to claim 43, wherein the distribution of the physiological values comprises a spatial distribution.

46. A method according to claim 43, comprising pacing the heart using the determined pacing regime.

47. A method according to claim 43, wherein changing the distribution of the physiological values comprises maintaining physiological values within a given range.

48. A method according to claim 42, wherein the physiological values are determined substantially simultaneously.

49. A method according to claim 42, wherein the physiological value comprises perfusion.

50. A method according to claim 42, wherein the physiological value comprises stress.

51. A method according to claim 42, wherein the physiological value comprises plateau duration.

52. A method according to claim 42, wherein determining the physiological value comprises measuring activation time using electrodes.

53. A method according to claim 1, and comprising determining, using at least one of the maps, a preferred pacing regime for the heart which is optimal with respect to a physiological variable.

54. A method according to claim 53, comprising pacing the heart using the preferred pacing regime.

55. A method according to claim 1, wherein generating the maps comprises generating electrical maps.

56. A method according to claim 53, wherein determining the preferred pacing regime comprises generating a map of the activation profile of the heart.

57. A method according to claim 1, wherein generating the maps comprises generating mechanical maps.

58. A method according to claim 53, wherein the physiological variable comprises a stroke volume.

59. A method according to claim 53, wherein the physiological variable comprises a ventricular pressure profile.