Method and apparatus for determining the coronary sinus vein branch accessed by a coronary sinus lead

• US 7,881,794 B2
• Filed: 08/06/2007
• Issued: 02/01/2011
• Est. Priority Date: 03/30/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Spinelli, Julio, Mah, Jeng, Yu, Yinghong, Ding, Jiang
• Primary Examiner(s): Getzow; Scott M
• Application Number:
  US11/834,484
• Publication Number:
  US 20070270915A1
• Time in Patent Office: 1,275 Days
• Field of Search: 607/9, 607/27, 607/28, 607/62, 600508-510
• US Class Current: 607/27
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• 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 1/3682 with a variable atrioventricular delay

Abstract

Systems and methods for determining the coronary sinus vein branch location of a left ventricle electrode are disclosed. The systems and methods involve detecting the occurrence of electrical events within the patient'"'"'s heart including sensing one or more of the electrical events with the electrode and then analyzing the electrical events to determine the electrode'"'"'s position. The determination of electrode position may be used to automatically adjust operating parameters of a VRT device. Furthermore, the determination of electrode position may be made in real-time during installation of the electrode and a visual indication of the electrode position may be provided on a display screen.

Claims

1. A method for installing an electrode of a VRT device in a left ventricle of a patient'"'"'s heart, the method comprising:

placing the electrode in a coronary sinus vein branch of the left ventricle;

detecting a plurality of electrical events in the patient'"'"'s heart during at least one heart beat, wherein at least one of the plurality of electrical events is sensed by the electrode;

determining from the plurality of electrical events whether the electrode has an anterior or a lateral/posterior vein branch position during the heart beat; and

adjusting settings used by the VRT device based upon the determined position of the electrode.

2. The method of claim 1, wherein the plurality of electrical events include an onset of a QRS complex at the electrode and a peak of the QRS complex at the electrode, wherein determining the vein branch position comprises computing an interval between the onset and the peak.

3. The method of claim 1, wherein the plurality of electrical events include a right ventricle QRS complex peak and left ventricle QRS complex peak at the electrode, wherein determining the vein branch position comprises computing an interval between the right ventricle QRS complex peak and the left ventricle QRS complex peak.

4. The method of claim 1, wherein the plurality of electrical events include atrial activity and a left ventricle QRS complex peak at the electrode, wherein determining the vein branch position comprises computing an interval between the atrial activity and the left ventricle QRS complex peak.

5. The method of claim 1, further comprising displaying on a screen an indication of the determined anterior or a lateral/posterior vein branch position of the electrode.

6. The method of claim 1, further comprising sending a pulse to an LV electrode using timing of output circuitry.

7. The method of claim 6, wherein sending the pulse includes accounting for a LV electrode position.

8. The method of claim 1, further comprising computing an interval between electrical events, and detecting whether the interval is valid.

9. The method of claim 8, further comprising re-sampling electrical events if the interval is outside of a range.

10. The method of claim 1, wherein determining includes determining a probability the electrode is in the anterior position.

11. A method for assisting installation of an electrode in a left ventricle of a patient'"'"'s heart, the method comprising:

placing the electrode in a coronary sinus vein branch of the left ventricle;

placing a second electrode in an atrium region;

detecting a plurality of electrical events in the patient'"'"'s heart during a heart beat, wherein detecting the plurality of electrical events includes sensing the events with the electrode;

computing an interval between electrical events, and detecting whether the interval is valid;

determining from the plurality of electrical events whether the electrode has an anterior or a lateral/posterior vein branch position during the heart beat; and

adjusting settings used by the VRT device based upon the determined position of the electrode.

12. The method of claim 11, wherein determining whether the electrode has an anterior or a lateral/posterior vein branch position during the heart beat comprises:

measuring an interval between a first depolarization event and a second depolarization event; and

comparing the interval to a threshold and determining a lateral/posterior position when the interval is greater than the threshold.

13. The method of claim 12, wherein the first depolarization event is detected by sensing depolarization at the second electrode in the atrium region.

14. The method of claim 12, further comprising sending a pulse to an LV electrode and accounting for a LV electrode position.

15. A method for assisting installation of an electrode in a left ventricle of a patient'"'"'s heart, the method comprising:

placing the electrode in a coronary sinus vein branch of the left ventricle;

placing a second electrode in a right ventricle area;

detecting a plurality of electrical events in the patient'"'"'s heart during a heart beat, wherein detecting the plurality of electrical events includes sensing the events with the electrode;

computing an interval between electrical events, and detecting whether the interval is valid;

determining from the plurality of electrical events whether the electrode has an anterior or a lateral/posterior vein branch position during the heart beat; and

adjusting settings used by the VRT device based upon the determined position of the electrode.

16. The method as recited in claim 15, wherein adjusting the settings includes automatically adjusting the settings used by the VRT device.

17. The method of claim 15, wherein determining whether the electrode has an anterior or a lateral/posterior vein branch position during the heart beat comprises:

measuring an interval between a first depolarization event and a second depolarization event; and

comparing the interval to a threshold and determining a lateral/posterior position when the interval is greater than the threshold.

18. The method of claim 15, wherein the first depolarization event is detected by sensing a peak of a QRS complex at the second electrode in the right ventricle area.

19. The method of claim 15, further comprising sending a pulse to an LV electrode and accounting for a LV electrode position.

20. The method of claim 15, wherein determining whether the electrode has the anterior or the lateral/posterior vein branch position during the heart beat includes determining a probability the electrode is in the anterior position.