Method of optimizing cardiac resynchronization therapy using sensor signals of septal wall motion
First Claim
1. A system for providing optimized cardiac chamber synchronization to a patient during delivery of cardiac pacing therapy, comprising:
- means for sensing a depolarization event of and/or providing a pacing stimulus to at least two chambers of a heart;
a single means for sensing acceleration, velocity or displacement of only a portion of an interchamber septal wall tissue of the heart disposed between said at least two chambers of the heart and providing a displacement signal thereof to the means for sensing a depolarization event and/or providing pacing stimulus; and
means for adjusting the timing for providing pacing stimulus to said heart to reduce or maintain the magnitude of the sensed displacement signal.
1 Assignment
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Accused Products
Abstract
The present invention relates to monitoring septal wall motion of the atrial and/or ventricular chambers of a heart for optimizing cardiac pacing intervals based on signals derived from the monitored wall motion. At least one lead of medical device is equipped with a motion sensor adapted to couple to septal tissue. The device receives and may post-process (e.g., suitably filter, rectify and/or integrate) motion signals to determine acceleration, velocity and/or displacement. During pacing interval optimization the wall motion is measured for those pacing intervals and the pacing interval setting(s) that produce minimal wall motion for chronic therapy delivery. In addition, methods for periodically determining whether to cease or resume delivery of a bi-ventricular pacing therapy to a patient that may have experienced beneficial reverse remodeling of the heart.
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Citations
40 Claims
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1. A system for providing optimized cardiac chamber synchronization to a patient during delivery of cardiac pacing therapy, comprising:
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means for sensing a depolarization event of and/or providing a pacing stimulus to at least two chambers of a heart; a single means for sensing acceleration, velocity or displacement of only a portion of an interchamber septal wall tissue of the heart disposed between said at least two chambers of the heart and providing a displacement signal thereof to the means for sensing a depolarization event and/or providing pacing stimulus; and means for adjusting the timing for providing pacing stimulus to said heart to reduce or maintain the magnitude of the sensed displacement signal. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. A method for providing optimized, closed-loop inter-chamber depolarization synchronization to a patient, consisting of:
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providing pacing stimulus to at least two chambers of a heart; sensing acceleration, velocity, or displacement using only portion of interchamber septal wall tissue of the heart and providing a displacement signal thereof; and adjusting a delay interval for a pacing stimulus to a one of said at least two chambers of the heart to reduce or maintain the magnitude of the displacement signal. - View Dependent Claims (9, 10, 11, 12, 13, 14)
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15. A computer-readable medium for storing instructions to perform a method for providing optimized, closed-loop cardiac resychronization therapy (CRT) to a patient, consisting of:
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instructions for sensing a depolarization of and/or providing pacing stimulus to at least two chambers of a heart; instructions for sensing acceleration, velocity or displacement using only a portion of interchamber septal wall tissue of the heart and providing a displacement signal thereof; and instructions adjusting a delay timing interval for a pacing stimulus to a one of said at least two chambers of the heart to reduce or maintain the magnitude of the displacement signal.
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16. A method for monitoring left ventricular function, comprising:
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deploying a motion sensor to a fixed location relative to a portion of a septal wall wherein the sensor generates a motion signal proportional to motion of the septal wall; opening a data collection window during a portion of a selected cardiac cycle phase; storing the motion signal throughout at least a part of the portion of the data collection window for a predetermined time interval or for more than one cardiac cycle; verifying a stability characteristic of the motion signal during the predetermined time interval or for more than one cardiac cycle; and determining a signal characteristic from the stored signal that is representative only of septal wall motion during delivery of a one of;
an atrial-based pacing therapy, an atrial-stimulation-only pacing therapy, a cardiac resynchronization therapy, a cardioversion therapy, a defibrillation therapy, a ventricular-stimulation-only pacing therapy. - View Dependent Claims (17, 18, 19, 20, 21)
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22. A computer readable medium programmed with instructions for performing a method for optimizing cardiac pacing intervals in a device programmed to operate a bi-ventricular cardiac pacing modality, comprising:
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instructions for sensing motion of a portion of a septal tissue of a heart with a deployed motion transducer and for providing a motion signal from the motion transducer; instructions for opening a data collection window during a portion of a selected cardiac cycle phase; instructions for storing the motion signal throughout at least a part of the portion of the data collection window for a predetermined time interval or for more than one cardiac cycle; instructions for verifying a stability characteristic of the motion signal during the predetermined time interval or for more than one cardiac cycle; instructions for averaging the stored motion signal; and instructions for determining a signal characteristic from the averaged stored signal that is representative of only septal wall motion. - View Dependent Claims (23, 24, 25, 26, 27, 28, 29)
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30. A method for optimizing cardiac pacing intervals based septal wall motion comprising;
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placing a motion sensor adapted for chronic in vivo implantation into electromechanical communication with only a portion of septal tissue so that the motion sensor generates a single dedicated motion signal proportional to the motion of the portion of septal tissue; enabling a temporal data collection window corresponding to a selected cardiac cycle phase; applying a cardiac pacing stimulus delivered according to a preselected set of test pacing parameters; sensing the motion signal during at least a part of the temporal data collection window or during a more than one cardiac cycle for at least some members of the preselected set of test pacing parameters; determining a signal characteristic from the sensed signal that is representative of relatively improved left ventricular function during each of the selected test pacing parameters; and storing a cardiac pacing timing parameter for a right ventricular pacing electrode and for a left ventricular pacing electrode that resulted in the single dedicated motion signal having the least magnitude.
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31. An apparatus for optimizing cardiac function, comprising:
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means for sensing motion of a portion of ventricular septal tissue and providing a motion signal; means for stimulating a first ventricular chamber and a second ventricular chamber at the same moment and at different moments during a single cardiac cycle; means for storing the sensed motion signals during a temporal window when the first ventricular chamber and the right ventricular chamber are stimulated at the same moment and at different moments; means for mathematically integrating the sensed motion signals at least once during a period of time corresponding to when the first ventricular chamber and the right ventricular chamber are contracting; means for comparing the mathematically integrated motion signals and determining a set of pacing parameters corresponding to an integrated motion signal having the least magnitude; and means for storing the set of pacing parameters. - View Dependent Claims (32)
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33. A method of determining if a bi-ventricular pacing therapy should be delivered to a patient, comprising:
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measuring a motion parameter of a portion of ventricular septal wall tissue during a period of time when an atrial-based pacing therapy is being delivered to a patient; comparing the measured motion parameter to either a predetermined therapy selection threshold or a prior measurement of ventricular wall motion of said patient which was obtained during a prior period of time when the atrial-based pacing therapy was being delivered; and in the event that the measured motion parameter either does not exceed the predetermined therapy selection threshold or exceeds the prior measurement, then withholding delivery of a bi-ventricular pacing therapy, or in the event that the measured motion parameter exceeds the predetermined therapy selection threshold or exceeds the prior measurement, then resuming delivery of the bi-ventricular pacing therapy. - View Dependent Claims (34, 35, 36)
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37. A computer readable medium for storing executable instructions for performing a method of determining if a bi-ventricular pacing therapy should be delivered to a patient, comprising:
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instructions for measuring a motion parameter of a portion of ventricular septal wall tissue during a period of time when an atrial-based pacing therapy is being delivered to a patient; instructions for comparing the measured motion parameter to either a predetermined therapy selection threshold or a prior measurement of ventricular wall motion of said patient which was obtained during a prior period of time when the atrial-based pacing therapy was being delivered; and instructions for withholding delivery of a bi-ventricular pacing therapy in the event that the measured motion parameter either does not exceed the predetermined therapy selection threshold or does not exceed the prior measurement, or instructions for resuming delivery of the bi-ventricular pacing therapy in the event that the measured motion parameter exceeds the predetermined therapy selection threshold or exceeds the prior measurement. - View Dependent Claims (38, 39, 40)
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Specification