Non-invasive method and apparatus for cardiac pacemaker pacing parameter optimization and monitoring of cardiac dysfunction
First Claim
1. An external programmer for an implantable cardiac pacing device, the external programmer comprising:
- a transmitter to transmit programming instructions to the implantable cardiac pacing device to program pacing parameters of the implantable cardiac pacing device;
a finger plethysmogram signal detector to provide a finger plethysmogram signal; and
a programmer processor coupled to the transmitter and the finger detector, the programmer programmed to generate the programming instructions, to control the transmitter for transmitting the programming instructions, to process the finger plethysmogram signal to detect pulsus alternans in the finger plethysmogram signal, and to derive a quantitative value related to a degree of the detected pulsus alternans.
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Abstract
A plethysmogram signal is sensed from a patient and provided to a programmer device for monitoring the condition of the patient and for optimizing pacing parameters of a cardiac device implanted in the patient. The programmer device analyzes the plethysmogram signal for cardiac performance associated with different pacing parameters. The cardiac performance is indicated by, for example, a pulse amplitude response, a degree of pulsus alternans, or irregularity in the pressure pulses detected in an atrial fibrillation patient. The pacing parameters resulting in the best cardiac performance are selected as the optimum pacing parameters. In one embodiment, the programmer device monitors a Valsalva maneuver performed by a patient. Optimum pacing parameters are derived by analysis of the plethysmogram signals obtained during performance of the Valsalva maneuver while the patient is paced using different pacing parameters.
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Citations
35 Claims
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1. An external programmer for an implantable cardiac pacing device, the external programmer comprising:
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a transmitter to transmit programming instructions to the implantable cardiac pacing device to program pacing parameters of the implantable cardiac pacing device; a finger plethysmogram signal detector to provide a finger plethysmogram signal; and a programmer processor coupled to the transmitter and the finger detector, the programmer programmed to generate the programming instructions, to control the transmitter for transmitting the programming instructions, to process the finger plethysmogram signal to detect pulsus alternans in the finger plethysmogram signal, and to derive a quantitative value related to a degree of the detected pulsus alternans. - View Dependent Claims (2, 3, 4)
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5. An external programmer for an implantable cardiac pacing device, the external programmer comprising:
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a transmitter to transmit programming instructions to the implantable cardiac pacing device to program pacing parameters of the implantable cardiac pacing device; a finger plethysmogram signal detector to provide a finger plethysmogram signal; and a programmer processor coupled to the transmitter and the finger detector, the programmer programmed to generate first programming instructions to control the implantable cardiac pacing device to pace for a plurality of series of paced beats using different selected pacing parameter values for different series of paced beats, to control the transmitter for transmitting the first programming instructions, and to analyze a selected characteristic of the finger plethysmogram signal for each series of paced beats of the plurality of paced beats, wherein the selected characteristic of the finger plethysmogram signal is selected from at least one of a pulse amplitude detected from the finger plethysmogram signal and a degree of pulsus alternans detected from the finger plethysmogram signal. - View Dependent Claims (6, 7, 8, 9, 10, 11)
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12. A non-invasive method for optimizing pacing parameters of a cardiac device implanted in a patient, the method comprising:
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detecting a finger plethysmogram signal from the patient during pacing with a selected pacing parameter value; monitoring a Valsalva maneuver performed by the patient while detecting the finger plethysmogram signal; analyzing the finger plethysmogram signal to obtain a cardiac performance parameter indicative of cardiac performance; adjusting the selected pacing parameter value; and obtaining an improvement in the cardiac performance parameter by repeating the detecting the finger plethysmogram signal, the monitoring the Valsalva maneuver, the analyzing the finger plethysmogram signal, and the adjusting the selected pacing parameter value. - View Dependent Claims (13, 14, 15, 16, 17, 18)
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19. A non-invasive method for optimizing pacing parameters of a cardiac device implanted in a patient, the method comprising:
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detecting a finger plethysmogram signal from the patient during pacing with a selected pacing parameter value; analyzing the finger plethysmogram signal to monitor a degree of pulsus alternans; adjusting the selected pacing parameter value; and reducing the degree of pulsus alternans by repeating the detecting the finger plethysmogram signal, the analyzing the finger plethysmogram signal, and the adjusting the selected pacing parameter value. - View Dependent Claims (20, 21, 22)
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23. A non-invasive method for optimizing pacing parameters of a cardiac device implanted in a patient, the method comprising:
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detecting a finger plethysmogram signal from the patient during pacing with a selected pacing parameter value; analyzing the finger plethysmogram signal to monitor a finger plethysmogram pulse amplitude in response to the pacing; adjusting the selected pacing parameter value; and increasing the finger plethysmogram pulse amplitude in response to the pacing by repeating the detecting the finger plethysmogram signal, the analyzing the finger plethysmogram signal, and the adjusting the selected pacing parameter value. - View Dependent Claims (24, 25)
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26. A non-invasive method for optimizing pacing parameters of a cardiac device implanted in a patient, the method comprising:
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detecting a finger plethysmogram signal from the patient during pacing with a selected pacing parameter value; analyzing the finger plethysmogram signal to monitor pulse pressure; adjusting the selected pacing parameter value; and regularizing the pulse pressure by repeating the detecting the finger plethysmogram signal, the analyzing the finger plethysmogram signal, and the adjusting the selected pacing parameter value. - View Dependent Claims (27, 28)
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29. A non-invasive method for optimizing pacing parameters of a cardiac device, the method comprising:
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delivering a pacing sequence including a plurality of series of paced beats, each of the series of paced beats preceded and followed by a series of non-paced beats and associated with one value of at least one pacing parameter, with a different value of the at least one pacing parameter used for each of the series of paced beats; detecting a finger plethysmogram signal during the delivery of the pacing sequence; analyzing the finger plethysmogram signal to monitor a parameter indicative of cardiac performance; and optimizing the at least one pacing parameter based on the analysis of the finger plethysmogram signal. - View Dependent Claims (30, 31, 32, 33, 34, 35)
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Specification