Automated optimization of multi-electrode pacing for cardiac resynchronization

• US 8,036,743 B2
• Filed: 03/31/2006
• Issued: 10/11/2011
• Est. Priority Date: 03/31/2005
• Status: Active Grant

• Current Assignee: Proteus Digital Health, Inc. (Otsuka Holdings Company Limited)
• Original Assignee: Proteus Biomedical, Inc. (Otsuka Holdings Company Limited)
• Inventors: Arne, Lawrence W., Costello, Benedict James, Omidvar, Fataneh A., Zdeblick, Mark J., Thompson, Todd, Colliou, Olivier, Savage, George M.
• Primary Examiner(s): Getzow; Scott
• Assistant Examiner(s): HULBERT, AMANDA K
• Application Number:
  US11/909,786
• Publication Number:
  US 20080294218A1
• Time in Patent Office: 2,020 Days
• Field of Search: 607/4, 607/5, 607/17
• US Class Current: 607/5
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• 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 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36571 controlled by blood flow rate, e.g. blood velocity or cardiac output
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

One embodiment of the present invention provides a system for automatically optimizing CRT procedures using a multi-electrode pacing lead. During operation, the system performs a first set of iterations to select one or more satellites on one or more pacing leads inserted in a patient. A pacing lead includes a plurality of pacing satellites, and a pacing satellite includes a plurality of electrodes that can be individually addressed and used for transmitting or detecting electric signals. The system then performs a second set of iterations to select one or more electrodes on the selected satellites. The system further performs a third set of iterations to select one or more timing configurations for pacing signals transmitted through one or more of the selected electrodes.

Claims

1. A method to perform automatic optimization of cardiac resynchronization therapy (CRT), the method comprising:

performing a first set of iterations to select at least one satellite from a plurality of satellites formed on at least one pacing lead inserted in a patient, wherein each satellite of the plurality of pacing satellites comprises;

a plurality of electrodes; and

a control chip communicatively coupled to each electrode of the plurality of electrodes;

performing a second set of iterations to select at least one electrode from each one of the at least one satellite selected from the plurality of satellites when the at least one electrode in the each one of the at least one satellite is addressed and controlled through a respective control chip of the each one of the at least one satellite upon a receipt of configuration signals configured to select the at least one electrode; and

performing a third set of iterations to select at least one timing configuration for pacing signals transmitted through the at least one electrode on the each one of the at least one satellite.

2. The method of claim 1, wherein the plurality of electrodes comprise at least one sensor.

3. The method of claim 2, wherein the at least one sensor is an accelerometer, a strain gauge, an angle gauge, a pressure sensor, or a temperature sensor.

4. The method of claim 1, wherein the performing the first set of iterations comprises:

iteratively transmitting a pacing signal through the plurality of satellites, wherein each iteration of the transmitting the pacing signal is performed on a different satellite in the plurality of satellites; and

selecting the at least one satellite based on a cardiac response resulting from the pacing signal through the plurality of satellites.

5. The method of claim 4, wherein the configuration signals are forwarded from a pacing can communicatively coupled to the each electrode of the plurality of electrodes in the each satellite, and wherein the iteratively transmitting the pacing signal through the plurality of satellites comprises iteratively transmitting the pacing signal from the pacing can as a signal source and the plurality of satellites as a signal sink.

6. The method of claim 5, wherein the pacing can and the plurality of satellites are electrically coupled via a two-wire conductor formed along the at least one pacing lead.

7. The method of claim 4, wherein the iteratively transmitting the pacing signal through the plurality of satellites is performed using a first set of the plurality of satellites as a signal source and a second set of the plurality of satellites as a signal sink.

8. The method of claim 4, wherein the selecting the at least one satellite based on the cardiac response comprises determining an occurrence of a cardiac contraction in response to the pacing signal.

9. The method of claim 1, wherein the performing the second set of iterations comprises:

iteratively transmitting a pacing signal through the plurality of electrodes on the each one of the at least one satellite, wherein each iteration of the transmitting the pacing signal is performed on a different electrode in the plurality of electrodes; and

selecting the at least one electrode based on a cardiac response resulting from the pacing signal through the plurality of electrodes.

10. The method of claim 9, wherein the configuration signals are forwarded from a pacing can communicatively coupled to the each electrode of the plurality of electrodes in the each satellite, and wherein the transmitting the pacing signal through the plurality of electrodes involves is performed using the pacing can as a signal source and the plurality of electrodes on the each one of the at least one satellite as a signal sink.

11. The method of claim 9, wherein the selecting the at least one electrode based on the cardiac response comprises selecting the at least one electrode through which the pacing signal resulting in a cardiac contraction is transmitted.

12. The method of claim 1, wherein performing the third set of iteration comprises:

iteratively transmitting a pacing signal through the at least one electrode on the each one of the at least one satellite, wherein the transmitting the pacing signal is performed with a different timing configuration; and

selecting the at least one pacing signal timing configuration based on a cardiac response resulting from the pacing signal through the at least one electrode on the each one of the at least one satellite.

13. The method of claim 12, wherein the transmitting the pacing signal through the at least one electrodes comprises:

transmitting a first pulse through a first one of the at least one electrode at a first location, and

transmitting a second pulse through a second one of the at least one electrode at a second location,

wherein the at least one timing configuration includes a time delay between the first pulse and the second pulse.

14. The method of claim 12, wherein the iteratively transmitting the pacing signal through the at least one electrode comprises performing a set of coarse-granularity iterations and a set of fine-granularity iterations, and wherein a timing-configuration difference between the coarse-granularity iterations is larger than a timing-configuration difference between the fine-granularity iterations.

15. The method of claim 14, wherein the timing-configuration difference between the coarse-granularity iterations is approximately five to ten times of the timing-configuration difference between the fine-granularity iterations.

16. The method of claim 14, wherein the timing-configuration difference between the coarse-granularity iterations is at least twice the timing-configuration difference between the fine-granularity iterations.

17. The method of claim 14, wherein the timing-configuration difference between the coarse-granularity iterations is approximately five to ten milliseconds, and wherein the timing-configuration difference between the fine-granularity iterations is approximately one millisecond.

18. The method of claim 14, wherein the selecting the at least one timing configuration based on the cardiac response comprises measuring a synchrony corresponding to each one of the at least one timing configuration, wherein after the coarse-granularity iterations, selecting the at least one timing configuration further comprises determining a collection of timing configurations that produce better synchrony than other timing configurations, and wherein the fine-granularity iterations are performed based on the collection of timing configurations determined after the coarse-granularity iterations.

19. The method of claim 18, wherein the determining the collection of timing configurations comprises identifying a broad peak based on a synchrony-versus-timing plot.

20. The method of claim 18, wherein the determining the collection of timing configurations comprises grouping the timing configurations based on a predetermined threshold.

21. The method of claim 18, wherein the measuring the synchrony comprises measuring a time difference between two response signals indicating a cardiac contraction at two corresponding locations.

22. The method of claim 21, wherein the measuring the time difference between the two response signals comprises comparing corresponding highest-slew-rate points of the two signals.

23. The method of claim 18, wherein the measuring the synchrony involves computing a cross-relation of two response signals indicating a cardiac contraction at two corresponding locations.

24. The method of claim 18, wherein the measuring the synchrony involves comparing electromechanical delays of two response signals indicating a cardiac contraction at two corresponding locations.

25. The method of claim 24, wherein the electromechanical delay of a signal is a time delay between a characteristic point of an electrocardiogram (ECG) and a characteristic point of the signal.

26. The method of claim 25, wherein the characteristic point of the ECG is a start of a QRS complex, and wherein the characteristic point of the signal is a corresponding peak of the signal.

27. The method of claim 18, wherein the selecting the at least one timing configuration comprises displaying an illustration of the synchrony corresponding to the timing configuration.

28. The method of claim 27, wherein the displaying the illustration of the synchrony comprises tracing a point in real time on an X-Y coordinate plane, wherein an X coordinate of the point indicates a value corresponding to an amplitude of a first response signal indicating a cardiac contraction at a first location, and wherein a Y coordinate of the point indicates a value corresponding to an amplitude of a second response signal indicating a cardiac contraction at a second location.

29. The method of claim 27, wherein the displaying the illustration of the synchrony comprises:

tracing a first point on a polar coordinate plane, wherein a radial coordinate of a first point indicates a value corresponding to an amplitude of a first signal indicating a cardiac contraction at a first location, and wherein an angular coordinate of the first point is configured to change at a constant rate;

tracing a second point on the polar coordinate plane, wherein a radial coordinate of a second point indicates a value corresponding to an amplitude of a second signal indicating a cardiac contraction at a second location, wherein an angular coordinate of the second point is configured to change at the constant rate; and

highlighting an area enclosed by both traces of the first point and the second point.

30. The method of claim 1, further comprising using a scripting language to automatically execute the performing the first set of iterations, the performing the second set of iterations, and the performing the third set of iterations.

31. The method of claim 30, further comprising saving values for response signals during the performing the first set of iterations, the performing the second set of iterations, and the performing the third set of iterations.

32. The method of claim 31, further comprising loading the values using the scripting language.

33. The method of claim 30, further comprising saving addresses for the at least one satellite and the at least one electrode on the each one of the at least one satellite and the at least one timing configuration using the scripting language.

34. The method of claim 33, further comprising loading the addresses for at least one satellite and the at least one electrode and the at least one timing configuration using the scripting language.

35. The method of claim 30, further comprising generating pacing procedures when the at least one satellite, the at least one electrode, and the at least one timing configuration are specified.

36. The method of claim 35, wherein the generating the pacing procedures comprises generating scripts that automatically perform the pacing procedures.