Hemodynamic optimization system for biventricular implants

• US 7,239,915 B2
• Filed: 11/16/2004
• Issued: 07/03/2007
• Est. Priority Date: 12/16/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Cohen, Todd J.
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US10/989,841
• Publication Number:
  US 20050131469A1
• Time in Patent Office: 959 Days
• Field of Search: 607 9- 28
• US Class Current: 607/17
• 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 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A system for monitoring a patient and treating the malfunctioning heart of the patient, either in an automatic mode or in a semiautomatic mode, includes means which derive at least one physiologic signal from or related to the patient'"'"'s circulatory system representative of hemodynamic status. A feedback loop is implemented in a biventricular implant, in order to automatically or selectively optimize the patient'"'"'s clinical hemodynamic status. Accordingly, the biventricular implant will be programmed to go through a series of AV delay, RV-LV timing and heart rate sequences which scan a preselected range of programmable values and apply those values to the patient'"'"'s heart. Hemodynamic patient measurements will be recorded and preferably graphed over those applied values. The optimal AV delay, RV-LV timing sequence and pacing rate can then be selected either manually by a technician, physician or other operator, or automatically via the implant in order to secure the best personalized timing sequence for the patient. Preferably, the implant will also be capable of automatically recording hemodynamic information and adjusting intervals, in order to optimize hemodynamics without third party intervention. Also preferably, the automatic adjusting feature can be selectively programmed on or off using the device programmer, to control manual or automatic intervention.

Claims

1. A multi-mode system for monitoring a patient and treating a malfunctioning heart of the patient selectively in automatic and semiautomatic modes, the system comprising:

means for deriving at least one physiological signal representative of a hemodynamic status of the patient, output means for providing at least one heart-malfunction-corrective output, range controlling means for limiting upper and lower bounds for said at least one heart-malfunction-corrective output, scanning means for varying delivery of said at least one heart-malfunction-corrective output, monitoring means for recording said at least one physiologic signal responsive to changes in delivery by said scanning means, and mode selection means operable by a human operator for enabling said means for providing the at least one heart-malfunction-corrective output to operate selectively in an automatic mode independent of said human operator and in semiautomatic mode requiring confirmation by said human operator, whereby at least one malfunction of the heart may be treated selectively in automatic and semiautomatic modes,

wherein said monitoring means for recording said at least one physiologic signal responsive to changes in delivery by said scanning means further comprises displaying said at least one physiologic signal responsive to changes in delivery by said scanning means.

2. A multi-mode system for monitoring a patient and treating a malfunctioning heart of the patient according to claim 1, wherein said at least one heart-malfunction-corrective output further comprises an electrical signal to said patient'"'"'s heart.

3. A multi-mode system for monitoring a patient and treating a malfunctioning heart of the patient according to claim 1, wherein said heart-malfunction-corrective output further comprises atrioventricular (AV) delay.

4. A multi-mode system for monitoring a patient and treating a malfunctioning heart of the patient according to claim 1, wherein said heart-malfunction-corrective output further comprises right ventricular (RV) to left ventricular (LV) timing.

5. A multi-mode system for monitoring a patient and treating a malfunctioning heart of the patient according to claim 1, wherein said heart-malfunction-corrective output further comprises heart rate adjustment.

6. A multi-mode system for monitoring a patient and treating a malfunctioning heart of the patient according to claim 1, wherein said heart-malfunction-corrective output further comprises atrioventricular (AV) delay, right ventricular (RV) to left ventricular (LV) timing, and heart rate adjustment.

7. A multi-mode system for monitoring a patient and treating a malfunctioning heart of the patient accord to claim 1, wherein said scanning means for varying delivery of said at least one heart-malfunction-corrective output is responsive to said range controlling means and restrained thereby within said upper and lower range bounds.

8. The multi-mode system for monitoring a patient and treating a malfunctioning heart of the patient of claim 1, wherein said displaying further comprises graphing.

9. A system for monitoring a patient and treating the malfunctioning heart of the patient through electrical signals generating by a biventricular pacemaker and coupled to said patient'"'"'s heart, comprising:

means for deriving at least one physiologic signal representative of said patient'"'"'s hemodynamic status;

means for varying at least one of atrioventricular (AV) delay, right ventricular (RV) to left ventricular (LV) timing and heart rate of said electrical signal;

a range of values for each said at least one of atrioventricular (AV) delay, right ventricular (RV) to left ventricular (LV) timing and heart;

a feedback loop which initiates said varying means to vary said at least one of said series of AV delay, RV-LV timing and heart rate of said electrical signals varied through said range of values;

a means to apply said electrical signals varied through said range of values to the patient'"'"'s heart;

recording means to measure said varied electrical signals and said physiologic signal responsive ti said varied electrical signals;

means to determine an optimum value from said range of values responsive to said recording means and said feedback loop; and

means to select at least one of an optimal AV delay, optimal RV-LV limiting sequence and an optimal pacing rate to secure an optimized timing sequence for said patient

wherein said recording means to measure said varied electrical signals and said physiologic signal responsive to said varied electrical signals further comprises a means to graph said physiologic signal with respect to said varied electrical signals.

10. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 9, wherein said range of values are programmable.

11. The system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker of claim 10, wherein said range of values are preselected by a human operator.

12. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 9, wherein said means to select at least one of an optimal AV delay, optimal RV-LV timing sequence and an optimal pacing rate further comprises a human operator manually selecting.

13. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 9, wherein said means to select at least one of an optimal AV delay, optimal RV-LV timing sequence and an optimal pacing rate further comprises said biventricular pacemaker automatically selecting.

14. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 9, wherein said feedback loop initiates said varying means to vary said atrioventricular (AV) delay, said right ventricular (RV) to left ventricular (LV) timing and said heart rate.

15. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker claim 9, wherein said feedback loop initiates said varying means to vary said atrioventricular (AV) delay.

16. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 9, wherein said feedback loop initiates said varying means to vary said right ventricular (RV) to left ventricular (LV) timing.

17. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 9, wherein said feedback loop initiates said varying means to vary said heart rate.

18. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 9, wherein said feedback loop initiates said varying means to vary said right ventricular (RV) to left ventricular (LV) timing and said heart rate.

19. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 9, further comprising means for automatically recording hemodynamic information and adjusting intervals to optimize hemodynamics without third party intervention, to automatically optimize said patient'"'"'s clinical hemodynamic status.

20. The system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker of claim 19, wherein said automatic recording means is selectively controlled to be alternatively operative and inoperative, to control manual or automatic intervention.

21. A system for monitoring a patient and treating the malfunctioning heart of the patient through electrical signals generating by a biventricular pacemaker and coupled to patient'"'"'s heart, comprising:

means for deriving at least one physiologic signal representative of said patient'"'"'s hemodynamic status;

means for varying each of a left artioventricular (AV) delay, a right atrioventricular (AV) delay, a right ventricular (RV) to left ventricular (LV) timing, and a heart rate using said electrical signals;

a feedback loop which initiates said varying means to vary at least one of said left and right AV delays, RV-LV timing and heart rate of said electrical signals through said range of values;

a means to apply said electrical signals varied through said range of values to the patient'"'"'s heart;

recording means to measure said electrical signals and said physiologic signal responsive to said varied electrical signals;

means to determine an optimum valued from said range of values responsive to said recording means and said feedback loop; and

means to select at one of an optimal pacing rate to secure an optimal right AV delay, an optimal RV-LV timing sequence and an optimal pacing rate to secure an optimized timing sequence for said patient

wherein said recording means to measure said varied electrical signals and said physiologic signal responsive to said varied electrical signals further comprises a means to graph said physiologic signal with respect to said varied electrical signals.

22. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said range of values are programmable.

23. A system for monitoring a patent and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said range of values are preselected by a human operator.

24. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said means to select at least one of an optimal left AV delay, an optimal right AV delay, and optimal RV-LV timing sequence and an optimal pacing rate further comprises a human operator manually selecting.

25. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said means to select at least one of an optimal left AV delay, an optimal right AV delay, an optimal RV-LV timing sequence and an optimal pacing rate further comprises said biventricular pacemaker automatically selecting.

26. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said feedback loop initiates said varying means to vary said left atrioventricular (AV) delay, said right atrioventricular (AV) delay, and right ventricular (RV) to left ventricular (LV) timing and said heart rate.

27. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said feedback loop initiates said varying means to vary said left atrioventricular (AV) delay.

28. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said feedback loop initiates said varying means to vary said right atrioventricular (AV) delay.

29. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said feedback loop initiates said varying means to vary said right ventricular (RV) to left ventricular (LV) timing.

30. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said feedback loop initiates said varying means to vary said heart rate.

31. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, wherein said feedback loop initiates said varying means to vary said right ventricular (RV) to left ventricular (LV) timing and said heart rate.

32. A system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker according to claim 21, further comprising means for automatically recording hemodynamic information and adjusting intervals to optimize hemodynamics without third party intervention, to automatically optimize said patient'"'"'s clinical hemodynamic status.

33. The system for monitoring a patient and treating the malfunctioning heart of the patient by a biventricular pacemaker of claim 32, wherein said automatic recording means is selectively controlled to be alternatively operative and inoperative, to control manual or automatic intervention.