Method and apparatus for optimizing stroke volume during DDD resynchronization therapy using adjustable atrio-ventricular delays

• US 7,158,830 B2
• Filed: 12/09/2002
• Issued: 01/02/2007
• Est. Priority Date: 05/08/1998
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Spinelli, Julio C., Yu, Yinghong, Ding, Jiang, Kramer, Andrew P.
• Primary Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US10/314,899
• Publication Number:
  US 20030144702A1
• Time in Patent Office: 1,485 Days
• Field of Search: 607/9, 607/17, 607/18, 607 23- 25, 607/27
• US Class Current: 607/23
• 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

Abstract

A pacing system for providing optimal hemodynamic cardiac function for parameters such as ventricular synchorny or contractility (peak left ventricle pressure change during systole or LV+dp/dt), or stroke volume (aortic pulse pressure) using system for calculating atrio-ventricular delays for optimal timing of a ventricular pacing pulse. The system providing an option for near optimal pacing of multiple hemodynamic parameters. The system deriving the proper timing using electrical or mechanical events having a predictable relationship with an optimal ventricular pacing timing signal.

Claims

1. A system, comprising:

a signal input including;

a cardiac signal input to receive at least one intracardiac electrogram indicative of cardiac events including at least one atrial event, A; and

a mechanical signal input to receive at least one pressure signal indicative of a predetermined pressure event, X;

a measurement module, coupled to the signal input, to measure a time interval (AX) between A and X using the intracardiac electrogram and the pressure signal; and

an atrio-ventricular delay (AVD) calculator coupled to the measurement module, the AVD calculator adapted to calculate an AVD using the AX and a predetermined equation relating the AX to an optimal AVD to provide a maximum aortic pulse pressure by delivering ventricular pacing pulses with the optimal AVD.

2. The system of claim 1, wherein the AVD calculator is adapted to calculate the AVD by using an equation:

AVD=M3·

AX−

M4, where M3 and M4 are predetermined coefficients.

3. The system of claim 2, further comprising a memory circuit to store M3 and M4.

4. The system of claim 1, further comprising an implantable device including a therapy circuit adapted to deliver the ventricular pacing pulses with the AVD.

5. The system of claim 4, wherein the at least one pressure signal comprises a pulse pressure providing for approximately maximum aortic pulse pressure indicative of an approximately optimal stroke volume, and further comprising a pressure sensor adapted to sense the pulse pressure.

6. The system of claim 4, wherein the implantable device comprises the signal input, the measurement module, and the AVD calculator.

7. The system of claim 4, furthering comprising a programmer communicatively coupled to the implanted device via a telemetry link, the programmer including the signal input, the measurement module, and the AVD calculator.

8. The system of claim 4, wherein the implantable device comprises the signal input and the measurement module, and furthering comprising a programmer communicatively coupled to the implanted device via a telemetry link, the programmer including the AVD calculator.

9. The system of claim 4, wherein the implantable device comprises the signal input, and furthering comprising a programmer communicatively coupled to the implanted device via a telemetry link, the programmer including the measurement module and the AVD calculator.

10. The system of claim 4, wherein the implantable device comprises the cardiac signal input, and furthering comprising a programmer communicatively coupled to the implanted device via a telemetry link, the programmer including the mechanical signal input, the measurement module and the AVD calculator.

11. A computer-readable device, comprising:

a computer-readable medium having computer-executable instructions to cause a computer or computer-based system to perform functions comprising;

receiving a time interval (AX) between an atrial event (A) detected from an intracardiac electrogram and a predetermined intracardiac pressure event (X) detected from a pressure signal; and

calculating an atrio-ventricular delay (AVD) using the AX and a predetermined equation relating the AX to an optimal AVD to provide a maximum aortic pulse pressure by delivering ventricular pacing pulses with the optimal AVD.

12. The computer-readable device of claim 11, wherein receiving the AX comprises receiving a time interval between an intrinsic atrial contraction and an end of a left atrial systolic pressure.

13. The computer-readable device of claim 11, wherein receiving the AX comprises receiving a time interval between an intrinsic atrial contraction and a peak of a left ventricular presystolic pressure.

14. The computer-readable device of claim 11, wherein receiving the AX comprises receiving a time interval between a delivery of an atrial pacing pulse and an end of a left atrial systolic pressure.

15. The computer-readable device of claim 11, wherein receiving the AX comprises receiving a time interval between a delivery of an atrial pacing pulse and a peak of a left ventricular presystolic pressure.

16. The computer-readable device of claim 11, wherein calculating the AVD comprises calculating the AVD by using an equation:

AVD=M3·

AX−

M4, where M3 and M4 are predetermined coefficients.

17. The computer-readable device of claim 11, wherein the functions further comprise measuring the AX.

18. The computer-readable device of claim 17, wherein the functions further comprise receiving event markers representing A and X.

19. The computer-readable device of claim 17, wherein the functions further comprise detecting at least one of A and X.

20. The computer-readable device of claim 17, wherein the functions further comprise receiving the intracardiac electrogram and the pressure signal.