Method and apparatus for trending a physiological cardiac parameter

• US 7,171,258 B2
• Filed: 06/25/2003
• Issued: 01/30/2007
• Est. Priority Date: 06/25/2003
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Goode, Paul
• Primary Examiner(s): Manual; George
• Assistant Examiner(s): Faulcon, Jr.; Lenwood
• Application Number:
  US10/603,876
• Publication Number:
  US 20040267142A1
• Time in Patent Office: 1,315 Days
• Field of Search: 607/17, 607/27, 607/122, 600/509
• US Class Current: 600/509
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• 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 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system

Abstract

The present invention relates to an implantable cardioverter-defibrillator or pacemaker whose standard circuitry is used to trend a physiological cardiac parameter using intra-cardiac impedance measurements. The trend information may be used to predict the onset of a sudden cardiac death (SCD) event. By being able to predict the onset of an SCD event, patients and their physicians may be forewarned of a life-threatening event allowing them to respond accordingly. The trend information may also be used to predict the efficacy of cardiac-related medications, monitor progress of congestive heart failure, detect the occurrence of myocardial infarction, or simply track changes in sympathetic tone.

Claims

1. A method of predicting sudden cardiac death comprising:

determining intra-cardiac impedance;

deriving at least one physiologic cardiac parameter from the determined impedance, the physiological cardiac parameter comprising an ejection fraction;

generating trended data by trending the derived physiologic cardiac parameter over spaced time intervals; and

predicting the onset of a sudden cardiac death episode using the trended data.

2. The method of claim 1 wherein the predicting comprises the steps of:

comparing trends of the at least one physiologic cardiac parameter; and

detecting one or more differences between the trends.

3. A method of predicting sudden cardiac death comprising:

determining intra-cardiac impedance;

deriving at least one physiologic cardiac parameter from the determined impedance, wherein the deriving comprises;

deriving the at least one physiologic cardiac parameter when a patient is at rest; and

deriving the at least one physiologic cardiac parameter when the patient is not at rest;

detecting a difference between the at least one physiologic cardiac parameter when the patient is at rest and the at least one physiologic cardiac parameter when the patient is not at rest;

trending the derived at least one physiologic cardiac parameter over spaced time intervals; and

predicting the onset of a sudden cardiac death episode using the difference.

4. The method of claim 3 wherein the determining intra-cardiac impedance comprises measuring intra-cardiac impedance with an implanted device by applying a current between two electrodes of the device and measuring a resulting voltage that is used to calculate the intra-cardiac impedance.

5. A method of trending a cardiac parameter, comprising:

measuring an intra-cardiac impedance;

deriving a physiologic cardiac parameter using the measured impedance; and

generating trend data by trending the derived parameter over time; and

monitoring, using the trend data, at least one of a drug regimen, a progress of a congestive heart failure disease condition, and an occurrence of a myocardial infarction.

6. The method of claim 5 wherein the measuring comprises applying a current to a lead positioned within the heart, determining a voltage as a result of the applied current, and calculating an impedance based on the voltage.

7. The method of claim 5 wherein the impedance is measured at spaced time intervals.

8. The method of claim 5 wherein the physiologic cardiac parameter represents sympathetic nervous activity.

9. The method of claim 5 wherein tracking predetermined physiological indicators comprises predicting a sudden cardiac death episode using ejection fraction trend data.

10. The method of claim 5 wherein the monitoring comprises monitoring a drug regimen.

11. The method of claim 5 wherein the monitoring comprises detecting the occurrence of a myocardial infarction.

12. The method of claim 5 wherein the monitoring comprises monitoring progress of congestive heart failure.

13. The method of claim 5 wherein the deriving comprises calculating the parameter using the measured impedance and storing one or more calculated impedance values into an array.

14. The method of claim 13 wherein the trending comprises comparing parameter values stored in the array.

15. The method of claim 5 comprising generating a signal when the trending data indicates that a threshold value for the predetermined physiological indicator has been met.

16. The method of claim 5 comprising transmitting the trend data using a communications system.

17. The method of claim 5 comprising transmitting the trend data to a patient management system.

18. The method of claim 5 wherein the measuring, deriving, and trending are completed by a unitary implanted device.

19. A computer-readable medium having computer-executable instructions for the method recited in claim 5.

20. A computer data signal embodied in a carrier wave readable by a computing system and encoding a computer program of instructions for executing a computer program of instructions for executing a computer program performing the method recited in claim 5.