Methods and systems for use in selecting cardiac pacing sites

• US 8,180,428 B2
• Filed: 04/09/2009
• Issued: 05/15/2012
• Est. Priority Date: 10/03/2007
• Status: Expired due to Fees

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Kaiser, Daniel R., Neidert, Michael R., Skadsberg, Nicholas David, Gardeski, Kenneth C., Mulligan, Lawrence J., Kelley, James F., Shelton, Michael B., Fischer, Trent M.
• Primary Examiner(s): Casler, Brian
• Assistant Examiner(s): Lauritzen, Amanda
• Application Number:
  US12/421,176
• Publication Number:
  US 20090198298A1
• Time in Patent Office: 1,132 Days
• Field of Search: 600/508, 600/527, 600/536, 600/407, 600/410, 600/411, 600/425, 600/427, 600/424, 600/429, 600/374, 606/130, 378/4, 607/17, 607/7, 607/9, 607/18
• US Class Current: 600/411
• CPC Class Codes: A61B 5/1104 induced by stimuli or drugs; A61B5/1102 takes precedence; investigating medicinal preparations G01N33/15
• CPC Class Codes: A61B 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61B 5/6882 Anchoring means
• CPC Class Codes: A61N 1/0573 chacterised by means penetrating the heart tissue, e.g. helix needle or hook
• 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 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 2001/0585 Coronary sinus electrodes

Abstract

A method and system for use in selecting a cardiac pacing site includes sensors for tracking wall motion (e.g., sensors coupled to the right and left ventricular heart wall). The wall motion of one or more non-paced cardiac cycles is compared to the wall motion of one or more paced cardiac cycles to determine the effectiveness of one or more pacing sites. For example, image data may be generated to notify the user as to the effectiveness of the one or more pacing sites.

Claims

1. A system for use in selecting at least one cardiac pacing site, the system comprising:

a first elongate lead configured to be positioned along a right ventricular heart wall, wherein the first elongate lead comprises a first electromagnetic sensor in which a first signal is induced when positioned in a magnetic field, wherein the first signal is usable to track wall motion when the first elongate lead is directed to a first position along the right ventricular heart wall;

a second elongate lead configured to be positioned along a left ventricular heart wall, wherein the second elongate lead comprises a second electromagnetic sensor in which a second signal is induced when positioned in a magnetic field, wherein the second signal is usable to track wall motion when the second elongate lead is directed to a second position along the left ventricular heart wall;

a controller configured to receive non-paced heart wall motion data based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions, wherein the controller is further configured to receive paced heart wall motion data based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions and cardiac pacing stimulation is applied at one or more first pacing sites, and further wherein the controller is configured to execute a program to generate image data representative of a comparison of non-paced heart wall motion and paced heart wall motion based on at least a portion of the non-paced heart wall motion data and at least a portion of the paced heart wall motion data, wherein the image data representative of the comparison is indicative of the effectiveness of pacing at the one or more first pacing sites; and

a display to visualize the image data representative of the comparison to assist a user in selecting at least one pacing site.

2. The system of claim 1, wherein the controller is configured to receive non-paced heart wall motion data comprising non-paced motion loop data representative of heart wall motion during at least one non-paced cardiac cycle collected based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions,

wherein the controller is further configured to receive paced heart wall motion data comprising paced motion loop data representative of heart wall motion during at least one paced cardiac cycle collected based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions and cardiac pacing stimulation is applied at the one or more first pacing sites,

and further wherein the controller is configured to execute a program to generate image data representative of first and second motion loops corresponding to the motion of the heart wall during the at least one non-paced cardiac cycle based on the non-paced motion loop data and to generate image data representative of first and second motion loops corresponding to the motion of the heart wall during the at least one paced cardiac cycle based on the paced motion loop data, wherein the display is operable to visualize the image data representative of first and second motion loops corresponding to the motion of the heart wall during the at least one non-paced cardiac cycle and the image data representative of first and second motion loops corresponding to the motion of the heart wall during the at least one paced cardiac cycle.

3. The system of claim 2, wherein the image data comprises data for displaying a first and second loop corresponding to the motion of the heart wall during the at least one non-paced cardiac cycle, wherein the image data comprises data for displaying a first and second loop corresponding to the motion of the heart wall during the at least one paced cardiac cycle, and further wherein the display is operable to display the first and second loop corresponding to the motion of the heart wall during the at least one non-paced cardiac cycle and the first and second loop corresponding to the motion of the heart wall during the at least one paced cardiac cycle relative to a representation of the heart.

4. The system of claim 1, wherein the controller is configured to receive non-paced heart wall motion data comprising non-paced motion loop data representative of heart wall motion during multiple non-paced cardiac cycles collected based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions, wherein the controller is further configured to receive paced heart wall motion data comprising paced motion loop data representative of heart wall motion during multiple paced cardiac cycles collected based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions and cardiac pacing stimulation is applied at the one or more first pacing sites,

and further wherein the controller is configured to execute a program associated therewith to:

generate non-paced motion loop data representative of first and second motion loops corresponding to the motion of the heart wall at the respective first and second positions during each of the multiple non-paced cardiac cycles based on the non-paced motion loop data;

generate paced motion loop data representative of first and second motion loops corresponding to the motion of the heart wall at the respective first and second positions during each of the multiple paced cardiac cycles based on the paced motion loop data;

generate non-paced image data representative of a comparison of heart wall motion at the respective first and second positions for each of the multiple non-paced cardiac cycles based on the non-paced motion loop data;

generate paced image data representative of a comparison of heart wall motion at the respective first and second positions for each of the multiple paced cardiac cycles based on the paced motion loop data, wherein the display is operable to visualize the non-paced and paced image data for each of the multiple cardiac cycles.

5. The system of claim 4, wherein the controller is configured to execute a program to generate non-paced image data representative of distances between corresponding points of the first motion loop relative to the second motion loop for each of the multiple non-paced cardiac cycles based on the non-paced motion loop data and to generate paced image data representative of distances between corresponding points of the first motion loop relative to the second motion loop for each of the multiple paced cardiac cycles based on the paced motion loop data.

6. The system of claim 1, wherein the controller is configured to receive non-paced heart wall motion data comprising non-paced wall motion data representative of heart wall motion during multiple non-paced cardiac cycles collected based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions,

wherein the controller is further configured to receive paced heart wall motion data comprising paced wall motion data representative of heart wall motion during multiple paced cardiac cycles collected based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions and cardiac pacing stimulation is applied at the one or more first pacing sites,

and further wherein the controller is configured to execute a program to generate image data representative of the difference in phase of heart wall motion at the first and second positions in the time domain based on the non-paced wall motion data and the paced wall motion data for each of the multiple cardiac cycles.

7. The system of claim 1, wherein the controller is configured to receive non-paced heart wall motion data comprising non-paced wall motion data representative of heart wall motion during at least one non-paced cardiac cycle collected based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions,

wherein the controller is further configured to receive paced heart wall motion data comprising paced wall motion data representative of heart wall motion during at least one paced cardiac cycle collected based on signals induced in each of the first and second electromagnetic sensors when the first and second electromagnetic sensors are secured at the corresponding first and second positions and cardiac pacing stimulation is applied at the one or more first pacing sites,

and further wherein the controller is configured to execute a program to generate image data representative of the relative rotation of the heart from apex to base based on the non-paced wall motion data and the paced wall motion data.

8. The system of claim 1, wherein the controller is configured to execute a program to perform time domain analysis to determine a degree of synchrony between the wall motion at the position along the right ventricle and the wall motion at the position along the left ventricle based on at least a portion of the non-paced heart wall motion data and at least a portion of the paced heart wall motion data.

9. The system of claim 1, wherein the controller is configured to execute a program to perform torsional analysis to determine a relative rotation between the position along the right ventricular wall and the position along the left ventricular wall based on at least a portion of the non-paced heart wall motion data and at least a portion of the paced heart wall motion data.

10. A non-transitory computer-readable medium having stored thereon at least one instruction that, when executed by a computer, causes the computer to:

receive non-paced heart wall motion data representative of the motion of first and second sensors of first and second elongate leads secured at corresponding first and second positions along a right ventricular heart wall and a left ventricular heart wall, respectively;

receive paced heart wall motion data representative of the motion of the first and second sensors secured at the first and second positions along the right ventricular heart wall and the left ventricular heart wall, respectively, when cardiac pacing stimulation is applied at one or more first pacing sites;

generate data representative of a comparison of non-paced heart wall motion and paced heart wall motion based on at least a portion of the non-paced heart wall motion data and at least a portion of the paced heart wall motion data, wherein the image data representative of the comparison is indicative of the effectiveness of pacing at the one or more first pacing sites; and

generate notification data indicative of the one or more first pacing sites being one of an optimal pacing site and a non-optimal pacing site.

11. The computer-readable medium of claim 10, having stored thereon at least one instruction that, when executed by the computer, causes the computer to:

generate image data representative of a comparison of non-paced heart wall motion and paced heart wall motion based on at least a portion of the non-paced heart wall motion data and at least a portion of the paced heart wall motion data, wherein the image data representative of the comparison is indicative of the effectiveness of pacing at the one or more first pacing sites; and

visualize the image data representative of the comparison to assist a user in selecting at least one pacing site.

12. The computer-readable medium of claim 10, having stored thereon at least one instruction that, when executed by the computer, causes the computer to:

output image data for display to assist a user in introducing the first elongate lead to the first position along the right ventricular heart wall, the first elongate lead comprising a first electromagnetic receiver coil;

output image data for display to assist a user in coupling the first electromagnetic receiver coil at the first position along the right ventricular heart wall;

induce a first signal in the first electromagnetic receiver coil by generating a magnetic field, the first signal facilitating creation of a first virtual representation of at least a portion of the first elongate lead to direct the first elongate lead to the first position, and to track wall motion along the right ventricular heart wall;

output image data for display to assist a user in introducing the second elongate lead to the second position along a left ventricular heart wall, the second elongate lead comprising a second electromagnetic receiver coil;

output image data for display to assist a user in coupling the second electromagnetic receiver coil at the second position along the left ventricular heart wall;

induce a second signal in the second electromagnetic receiver coil by generating a magnetic field, the second signal facilitating creation of a second virtual representation of a portion of the second elongate lead to direct the second elongate lead to the second position, and to track wall motion along the left ventricular heart wall;

store a set of non-paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

apply cardiac pacing stimulation at the one or more first pacing sites;

collect a set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

compare the set of non-paced heart wall motion data to the set of paced heart wall motion data; and

determine, based on the comparison, whether to maintain pacing at the one or more first pacing sites or to apply pacing stimulation at one or more second pacing sites for use in collection of a second set of paced heart wall motion data.

13. The computer-readable medium of claim 10, having stored thereon at least one instruction that, when executed by the computer, causes the computer to perform time domain analysis to determine a degree of synchrony between the wall motion at the position along the right ventricle and the wall motion at the position along the left ventricle based on at least a portion of the non-paced heart wall motion data and at least a portion of the paced heart wall motion data.

14. The computer-readable medium of claim 10, having stored thereon at least one instruction that, when executed by the computer, causes the computer to perform torsional analysis to determine a relative rotation between the first position along the right ventricular wall and the second position along the left ventricular wall based on at least a portion of the non-paced heart wall motion data and at least a portion of the paced heart wall motion data.

15. A method for use in selecting at least one cardiac pacing site, the method comprising:

introducing a first elongate lead to a position along a right ventricular heart wall, the first elongate lead including a first electromagnetic receiver coil;

coupling the first electromagnetic receiver coil at a first position along the right ventricular heart wall;

inducing a first signal in the first electromagnetic receiver coil by generating a magnetic field, the first signal facilitating creation of a first virtual representation of at least a portion of the first elongate lead to direct the first elongate lead to the first position, and to track wall motion along the right ventricular heart wall;

introducing a second elongate lead to a second position along a left ventricular heart wall, the second elongate lead including a second electromagnetic receiver coil;

coupling the second electromagnetic receiver coil at the second position along the left ventricular heart wall;

inducing a second signal in the second electromagnetic receiver coil by generating a magnetic field, the second signal facilitating creation of a second virtual representation of at least a portion of the second elongate lead to direct the second elongate lead to the second position, and to track wall motion along the left ventricular heart wall;

storing a set of non-paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

applying cardiac pacing stimulation at one or more first pacing sites;

collecting a set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the set of paced heart wall motion data;

determining, based on the comparison, whether to maintain pacing at the one or more first pacing sites or to apply pacing stimulation at one or more second pacing sites for collection of a second set of paced heart wall motion data;

generating notification data indicative of the one or more first pacing sites being one of an optimal pacing site and a non-optimal pacing site.

16. The method of claim 15, wherein the first position along the right ventricular heart wall comprises a septal position.

17. The method of claim 15, wherein the first position along the right ventricular heart wall comprises a position located in proximity to an apex of the heart, and further wherein the second position along the left ventricular heart wall comprises a position in proximity to a base of the heart.

18. The method of claim 15, wherein comparing the set of non-paced heart wall motion data to the set of paced heart wall motion data comprises performing a time domain analysis to determine a degree of synchrony between the wall motion at the position along the right ventricle and the wall motion at the position along the left ventricle.

19. The method of claim 15, wherein comparing the set of non-paced heart wall motion data to the set of paced heart wall motion data comprises performing a torsional analysis to determine a relative rotation between the position along the right ventricular wall and the position along the left ventricular wall.

20. The method of claim 15, wherein the one or more first cardiac pacing sites comprise a left ventricular pacing site and a right ventricular pacing site.

21. The method of claim 20, wherein the first elongate lead further includes an electrode employed for applying the pacing stimulation to the right ventricular pacing site.

22. The method of claim 20, wherein the second elongate lead further includes an electrode employed for applying the pacing stimulation to the left ventricular pacing site.

23. The method of claim 15, further comprising:

applying cardiac pacing stimulation at one or more second cardiac pacing sites;

collecting a second set of paced heart wall motion data from the signal of each of the electromagnetic receiver coils secured at the corresponding position;

comparing the set of non-paced heart wall motion data to the second set of paced heart wall motion data; and

determining, based on the comparison, whether to maintain pacing at the one or more first pacing sites, or the one or more second pacing sites, or to apply pacing stimulation at one or more third pacing sites for collection of a third set of paced heart wall motion data.

24. A method for use in selecting at least one cardiac pacing site, the method comprising:

coupling a first sensor at a first position along a right ventricular heart wall, the first sensor configured to track wall motion of the heart wall;

coupling a second sensor at a second position along a left ventricular heart wall, the second sensor configured to track motion of the heart wall,

collecting non-paced heart wall motion data based on the location of the first and second sensor at the corresponding positions;

applying cardiac pacing stimulation at one or more first pacing sites;

collecting paced heart wall motion data based on the location of the first and second sensor at the corresponding positions when the cardiac pacing stimulation is applied;

comparing the non-paced heart wall motion data to the paced heart wall motion data;

generating image data, using an imaging device, representative of the comparison of non-paced heart wall motion data and paced heart wall motion data, wherein the image data representative of the comparison is indicative of the effectiveness of pacing at the one or more first pacing sites; and

visualizing the image data representative of the comparison to assist a user in selecting a pacing site.

25. The method of claim 24, wherein the first position comprises a position located along a right ventricular septum.

26. The method of claim 24, wherein the first and second positions comprise positions located in proximity to an apex of the heart and located in proximity to a base of the heart, respectively.

27. The method of claim 24, wherein comparing the non-paced heart wall motion data to the paced heart wall motion data comprises performing a time domain analysis to determine a degree of synchrony between the wall motion at the first position and the wall motion at the second position.

28. The method of claim 24, wherein comparing the non-paced heart wall motion data to the paced heart wall motion data comprises performing a torsional analysis to determine a relative rotation between the first position and the second position.

29. The method of claim 24, wherein the one or more first pacing sites comprise a left ventricular pacing site and a right ventricular pacing site.

30. The method of claim 24, further comprising:

applying cardiac pacing stimulation at one or more second pacing sites;

collecting paced heart wall motion data based on the location of the sensors secured at the corresponding positions when the cardiac pacing stimulation is applied at the one or more second pacing sites;

comparing the non-paced heart wall motion data to the paced heart wall motion data collected when the cardiac pacing stimulation was applied at the one or more second pacing sites; and

determining, based on the comparison, whether to maintain pacing at the one or more first pacing sites, or at the one or more second pacing sites, or to apply pacing stimulation at one or more third pacing sites for collection of additional paced heart wall motion data.