Method and system for delivering cardiac resynchronization therapy with variable atrio-ventricular delay

• US 7,630,764 B2
• Filed: 08/18/2005
• Issued: 12/08/2009
• Est. Priority Date: 12/22/2003
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Morris, Milton M., Yu, Yinghong, Ding, Jiang
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US11/206,394
• Publication Number:
  US 20060047320A1
• Time in Patent Office: 1,573 Days
• Field of Search: 607 9- 28
• US Class Current: 607/9
• 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 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A pacing system computes optimal cardiac resynchronization pacing parameters using intrinsic conduction intervals. In various embodiments, values for atrio-ventricular delay intervals are each computed as a function of an intrinsic atrio-ventricular interval and a parameter reflective of an interventricular conduction delay. Examples of the parameter reflective of the interventricular conduction delay include QRS width and interval between right and left ventricular senses.

Claims

1. A system for delivering a cardiac resynchronization therapy to a heart having a first ventricle and a second ventricle, the system comprising:

a plurality of sensing/pacing channels to sense cardiac electrical activity and deliver pacing pulses; and

a controller coupled to the sensing/pacing channels, the controller adapted to compute a value for a first atrio-ventricular delay (AVD) interval for the first ventricle as a linear function of at least a measured first intrinsic atrio-ventricular interval for the first ventricle following an atrial pace and a parameter reflective of an interventricular conduction delay between the first ventricle and the second ventricle and to control the delivery of the pacing pulses to the first ventricle in accordance with an AV sequential pacing mode using the first AVD interval.

2. The system of claim 1, wherein the controller is adapted to determine the first AVD interval using at least the measured first intrinsic atrio-ventricular interval following the atrial pace and a QRS width.

3. The system of claim 1, wherein the controller is adapted to determine the first AVD interval using at least the measured first intrinsic atrio-ventricular interval following the atrial pace and an interval between right and left ventricular senses.

4. The system of claim 1, wherein the controller is programmed with predetermined coefficients used in the linear function, the predetermined coefficients derived from a linear regression analysis of clinical population data relating different intrinsic conduction measurements to an optimum AVD interval for delivering cardiac resynchronization therapy as determined by measurement of a cardiac function parameter.

5. The system of claim 1, wherein the controller is further adapted to compute a value for a second AVD interval for the first ventricle as a linear function at least a measured second intrinsic atrio-ventricular interval for the first ventricle following an atrial sense and the parameter reflective of the interventricular conduction delay and to control the delivery of the pacing pulses to the first ventricle in accordance with an AV sequential pacing mode using the first AVD interval and an atrial tracking mode using the second AVD interval.

6. A system for delivering a cardiac resynchronization therapy to a heart having a first ventricle and a second ventricle, the system comprising:

means for determining a first atrio-ventricular delay (AVD) interval for pacing the first ventricle in an atrio-ventricular sequential pacing mode as a linear function of a first intrinsic atrio-ventricular interval between an atrial pace and a ventricular sense for the first ventricle and a parameter reflective of an interventricular conduction delay between the first ventricle and the second ventricle and a second AVD interval for pacing the first ventricle in an atrial tracking mode as a linear function of a second intrinsic atrio-ventricular interval between an atrial sense and another ventricular sense for the first ventricle and the parameter reflective of the interventricular conduction delay; and

an implantable cardiac rhythm management device adapted to deliver the cardiac resynchronization therapy using the first AVD interval and the second AVD interval.

7. The system of claim 6, wherein the parameter reflective of the interventricular conduction delay is a QRS width.

8. The system of claim 6, wherein the parameter reflective of the interventricular conduction delay is an interval between right and left ventricular senses.

9. The system of claim 6, wherein the implantable cardiac rhythm management device comprises the means for determining the first AVD interval and the second AVD interval.

10. The system of claim 6, further comprising an external programmer communicatively coupled to the implantable cardiac rhythm management device via a wireless telemetry link.

11. The system of claim 10, wherein the external programmer comprises the means for determining the first AVD interval and the second AVD interval.

12. The system of claim 11, wherein the external programmer is adapted to present the first AVD interval and the second AVD interval.

13. The system of claim 11, wherein the external programmer is adapted to program the implantable cardiac rhythm management device automatically with the first AVD interval and the second AVD interval.

14. The system of claim 10, wherein the external programmer is adapted to present the first intrinsic atrio-ventricular interval, the second intrinsic atrio-ventricular interval and the parameter reflective of the interventricular conduction delay, and the means for determining the first AVD interval and the second AVD interval comprises a printed lookup table.

15. A method for optimizing an atrio-ventricular delay (AVD) interval used in a cardiac resynchronization therapy for a heart having a first ventricle and a second ventricle, the method comprising:

measuring a first intrinsic atrio-ventricular interval between an atrial pace and a ventricular sense for the first ventricle;

computing a values for a first AVD interval for the first ventricle as a linear function of the first intrinsic atrio-ventricular interval and a parameter reflective of an interventricular conduction delay between the first ventricle and the second ventricle; and

controlling delivery of pacing pulses to the first ventricle in accordance with an AV sequential pacing mode using the first AVD interval.

16. The method of claim 15, further comprising:

measuring a second intrinsic atrio-ventricular interval between an atrial sense and another ventricular sense for the first ventricle;

computing a values for a second AVD interval for the first ventricle as a linear function of the second intrinsic atrio-ventricular interval and the parameter reflective of the interventricular conduction delay; and

controlling delivery of pacing pulses to the first ventricle in accordance with an atrial tracking mode using the second AVD interval.

17. The method of claim 16, wherein the parameter reflective of the interventricular conduction delay is a QRS width.

18. The method of claim 16, wherein the parameter reflective of the interventricular conduction delay is an interval between right and left ventricular senses.

19. The method of claim 16, further comprising determining a biventricular offset using the parameter reflective of the interventricular conduction delay.

20. The method of claim 16, wherein determining the first AVD interval comprises computing a value for the first AVD interval using an implantable cardiac rhythm management device, and determining the second AVD interval comprises computing a value for the second AVD interval using the implantable cardiac rhythm management device.

21. The method of claim 16, wherein determining the first AVD interval comprises computing a value for the first AVD interval using an external programmer communicatively coupled to the implantable cardiac rhythm management device via a telemetry link, and determining the second AVD interval comprises computing a value for the second AVD interval using the external programmer.

22. The method of claim 21, further comprising programming the implantable cardiac rhythm management device using the computed value of the first AVD interval and the computed value of the second AVD interval.

23. The method of claim 21, further comprising presenting the computed value of the first AVD interval and the computed value of the second AVD interval in a form of a recommendation using the external programmer.

24. The method of claim 16, further comprising presenting the first intrinsic atrio-ventricular interval, the second intrinsic atrio-ventricular interval, and the QRS width, and wherein determining the value of the first AVD interval comprises determining the value of the first AVD interval using a printed lookup table, and determining the value of the second AVD interval comprises determining the value of the second AVD interval using the printed lookup table.

25. A method for pacing a heart having a first ventricle and a second ventricle, the method comprising:

measuring a first intrinsic atrio-ventricular interval for the first ventricle following an atrial pace;

measuring a second intrinsic atrio-ventricular interval for the first ventricle following an atrial sense;

measuring a parameter reflective of an interventricular conduction delay between the first ventricle and the second ventricle;

computing a first value for a first atrio-ventricular delay (AVD) interval for pacing the first ventricle in an atrio-ventricular sequential pacing mode as a linear function of the first intrinsic atrio-ventricular interval, the parameter reflective of the interventricular conduction delay, and a first plurality of predetermined coefficients; and

computing a second value for a second AVD interval for pacing the first ventricle in an atrial tracking mode as a linear function of the second intrinsic atrio-ventricular interval, the parameter reflective of the interventricular conduction delay, and a second plurality of predetermined coefficients.

26. The method of claim 25, further comprising deriving the first plurality of predetermined coefficients and the second plurality of predetermined coefficients from a linear regression analysis of clinical population data relating different intrinsic conduction measurements to an optimum AVD interval for delivering the cardiac resynchronization therapy as determined by measurement of a cardiac function parameter.

27. The method of claim 26, further comprising delivering pacing pulses to the first ventricle using the first AVD interval and the second AVD interval in a cardiac resynchronization therapy.

28. The method of claim 27, further comprising computing a biventricular offset using the parameter reflective of the interventricular conduction delay.

29. The method of claim 28, wherein the parameter reflective of the interventricular conduction delay is a QRS width.

30. The method of claim 28, wherein the parameter reflective of the interventricular conduction delay is an interval between right and left ventricular senses.