Expert system and method

• US 7,181,285 B2
• Filed: 12/26/2000
• Issued: 02/20/2007
• Est. Priority Date: 12/26/2000
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lindh, Par, Stahmann, Jeffrey E., Kalgren, James, Wentkowski, Rene H.
• Primary Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US09/748,791
• Publication Number:
  US 20020120311A1
• Time in Patent Office: 2,247 Days
• Field of Search: 607/4, 607/5, 607/7, 607/9, 607/11, 607/17, 607/30, 607/25, 600/300, 600/516
• US Class Current: 607/30
• 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 1/37235 Aspects of the external programmer
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

A medical device programmer and a method of operation in which a first data value is received and used in the execution of one or more algorithms. One or more suggested pulse generator settings are calculated from the one or more algorithms based on the first data value, and the one or more suggested pulse generator settings are displayed on an interactive display screen of the medical device programmer. In one embodiment, the first data value is a duration interval of a QRS complex. From the duration interval, suggestions are made as to one or more ventricular chambers in which to provide pacing pulses. Additionally, pacing intervals for an AV delay are suggested based on measured P-R intervals, or pacing intervals for an LV offset are suggested based on a measured duration interval of a V—V-interval between a right ventricular event and a left ventricular event.

Claims

1. A medical device programmer, comprising:

a data input for receiving PR interval durations measured by a pulse generator;

a data input for receiving a duration interval of a QRS complex and a timing relationship between the right and left ventrical depolarizations;

control circuitry for using at least first and second PR interval durations to select an AV delay interval for delivering one or more ventricle pacing pulses and for using the duration interval of the QRS complex and the timing relationship between right and left ventricular depolarizations to select among ventricular pacing sites in which to provide pacing pulses;

a display screen to display the selected AV delay interval and the selected ventricular pacing site or sites; and

an input to initiate programming the selected AV delay interval and ventricular pacing site or sites into the pulse generator.

2. The medical device programmer of claim 1, wherein the control circuitry includes a receiver/transmitter and a ventricular chamber selector coupled to the data input and the receiver/tramsmitter, the receiver/transmitter for receiving intrinsic intracardiac electrograms of a left and right ventricle and the ventricular chamber selector for determining the relationship between R_L and R_R, where R_L os a time at which a depolarization in the left ventricle occurred and R_R is a time at which the depolarization in a right ventricle occurred, and suggesting one or more ventricular chambers in which to provide pacing pulses based on the duration interval of the QRS complex and the relationship between R_L and R_R.

3. The medical device programmer of claim 2, wherein the ventricular chamber selector suggests pacing in the left ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_L occurs later than R_R.

4. The medical device programmer of claim 2, wherein the ventricular chamber selector suggests pacing in both the left ventricle and the right ventricle when the duration interval of the QRS complex is greater than or equal to 120 millisecond and R_L occurs later than R_R.

5. The medical device programmer of claim 2, wherein the ventricular chamber selector suggests pacing in the right ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_R occurs later than R_L or at the same time as R_L.

6. The medical device programmer of claim 1, wherein the control circuitry is configured to select an AV delay interval by computing a weighted average of the first and second PF interval durations.

7. The medical device programmer of claim 6, wherein the control circuitry is configured to compute the weighted average using and intrinsic coefficient when the most recent PR interval is concluded by an instrinsic beat and to compute the weighted average using a paced coefficient when the most recent PR is concluded by a paced beat.

8. The medical device programmer of claim 7, further comprising an input to receive selected instrinsic and paced coefficients for computing the weighted average.

9. The medical device programmer of claim 6, further comprising an input to receive selected weighting coefficient for computing the weighted average.

10. The medical device programmer of claim 1, further comprising control circuitry for using the timing relationship between right and left ventricular depolarizations to select an LV offset value for use in biventricular pacing.

11. A method for operating a medical for device programmer, comprising:

receiving PR interval durations measured by a pulse generator;

receiving a duration interval of QRS complex and a timing relationship between the right and left ventricular depolarizations;

using at least first and second PR interval durations to select an AV delay interval for delivering one or more ventricular pacing pulses;

using the duration interval of a QRS complex and the timing relationship between right and left ventricular depolarizations to select among ventricular pacing sites in which to provide pacing pulses;

displaying the selected AV delay interval and the selected ventricular pacing site or sites; and

programming the selected AV delay interval and ventricular pacing site or sites into the pulse generator.

12. The method of claim 11, further comprising determining the relationship between R_L and R_R, where R_L is a time at which a depolarization in the left ventricle occurred and R_R is a time at which the depolarization in a right ventricle occurred, and selecting one or more ventricular chambers in which to provide pacing pulses based on the duration interval of the QRS complex and the relationship between R_L and R_R.

13. The method of claim 12, further comprising selecting pacing in the left ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_L occurs later than R_R.

14. The method of claim 12, further comprising selecting pacing in both the left ventricle and the right ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_L occurs later than R_R.

15. The method of claim 12, further comprising selecting pacing in the right ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_R occurs later that R_L at the same time as R_L.

16. The method of claim 11, further comprising selecting an AV delay interval by computing a weighted average of the first and second PR interval durations.

17. The method of claim 16, further comprising computing the weighted average using an intrinsic coefficient when the most recent PR interval is concluded when the most recent PR interval is concluded by a paced beat.

18. The method of claim 11, further comprising using the timing relationship between right and left ventricular depolarizations to select an LV offset value for use in biventricular pacing.