Estimating acute response to cardiac resynchronization therapy

• US 8,229,557 B2
• Filed: 03/29/2007
• Issued: 07/24/2012
• Est. Priority Date: 03/29/2007
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Patangay, Abhilash, Siejko, Krzysztof, Krishnan, Mohan, Carlson, Gerrard M.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Bays, Pamela M
• Application Number:
  US11/729,453
• Publication Number:
  US 20080243202A1
• Time in Patent Office: 1,944 Days
• Field of Search: 607/4, 607/25, 607/27, 607/9, 607/17, 600/509
• US Class Current: 607/9
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• CPC Class Codes: A61B 5/0295 using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
• CPC Class Codes: A61B 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: A61B 5/0538 invasively, e.g. using a catheter
• CPC Class Codes: A61B 5/1102 Ballistocardiography
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/7267 involving training the classification device
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• 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 1/3684 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 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control

Abstract

Systolic timing intervals are measured in response to delivering pacing energy to a pacing site of a patient'"'"'s heart. An estimate of a patient'"'"'s acute response to cardiac resynchronization therapy (CRT) for the pacing site is determined using the measured systolic timing intervals. The estimate is compared to a threshold. The threshold preferably distinguishes between acute responsiveness and non-responsiveness to CRT for a patient population. An indication of acute responsiveness to CRT for the pacing site may be produced in response to the comparison.

Claims

1. A medical system, comprising:

an electrode for delivering at least one pacing pulse to a pacing site of a patient'"'"'s heart during a cardiac cycle;

an energy delivery and sensing unit coupled to the electrode;

a hemodynamic sensor;

another sensor;

a memory configured to store at least a threshold that distinguishes between acute responsiveness and non-responsiveness to cardiac resynchronization therapy (CRT) for a patient population, patient population data, and a fusion algorithm; and

a controller coupled to the memory, the hemodynamic sensor, the another sensor, and the energy delivery and sensing unit, the controller configured to;

measure systolic timing intervals of a plurality of different events of the cardiac cycle derived from a plurality of signals sensed during the cardiac cycle, at least one of the plurality of signals produced by the hemodynamic sensor and indicating a systolic timing interval of a mechanical cardiac event of the plurality of different events of the cardiac cycle, and at least another of the plurality of signals produced by the another sensor,

implement the fusion algorithm to combine the measured systolic timing intervals of the plurality of different events of the cardiac cycle and the patient population data to compute an estimate of probability of acute responsiveness to cardiac resynchronization therapy CRT for the pacing site,

compare the estimate to the threshold, and

generate an output indication of acute responsiveness or non-responsiveness of the pacing site to CRT based on the comparison of the estimate to the threshold.

2. The medical system of claim 1, wherein all of the plurality of systolic timing intervals are intervals of different mechanical events of the cardiac cycle.

3. The medical system of claim 1, wherein the controller is configured to measure signal amplitude from at least one of the signals of the plurality and implement the fusion algorithm using the measured systolic timing intervals and the at least one measured signal amplitude.

4. The medical system of claim 1, wherein controller implementation of the fusion algorithm comprises use of a linear regression parameter generated from the measured systolic timing intervals in computing the estimate.

5. The medical system of claim 1, wherein at least one of the signals of the plurality from which at least one of the systolic timing intervals is measured comprises an electrical cardiac signal indicating electrical activity of the heart during the cardiac cycle.

6. The medical system of claim 1, wherein the hemodynamic sensor comprises a cardiac stroke impedance sensor.

7. The medical system of claim 1, wherein the hemodynamic sensor comprises a heart sounds sensor.

8. The medical system of claim 1, wherein the hemodynamic sensor comprises a cardiac stroke impedance sensor and a heart sounds sensor, the controller measuring the systolic timing intervals derived from features of signals produced by the cardiac stroke impedance sensor and the heart sounds sensor.

9. The medical system of claim 1, wherein the system is configured for implantation in a patient.

10. The medical system of claim 1, wherein at least a portion of the system is configured for implantation in a patient and another portion of the system is configured for operation external to the patient.

11. The medical system of claim 1, wherein the plurality of systolic timing intervals are intervals of different electromechanical events of the cardiac cycle.

12. The medical system of claim 1, wherein the computed estimate of acute responsiveness is a binary indication between acute responsiveness and non-responsiveness to CRT for the pacing cite.

13. The medical system of claim 1, wherein the controller is further configured to calculate a confidence indication indicative of relative acute responsiveness to CRT for the pacing site.

14. The medical system of claim 13, wherein the controller is further configured to set an atrio-ventricular delay for the CRT based on the estimate of acute responsiveness to CRT and the confidence indication.

15. The medical system of claim 1, further comprising circuitry configured to output a human perceivable indication indicative of the computed estimate of acute responsiveness to CRT.

16. The medical system of claim 1, wherein the systolic timing intervals are measured in response to delivery of the at least one pacing pulse using one or more atrio-ventricular delay values.

17. The medical system of claim 1, wherein the hemodynamic sensor comprises an arteriole blood pressure sensor configured for implantation and to measure pressure of the arteriole system.

18. A medical system for delivering at least one pacing pulse to a pacing site of a patient'"'"'s heart during a cardiac cycle, the system comprising:

means for measuring systolic timing intervals of a plurality of different events of the cardiac cycle, at least one of the systolic timing intervals based on a mechanical cardiac event, the measuring means comprising at least a hemodynamic sensor and another sensor;

means for storing patient population data;

means for implementing a fusion algorithm to combine the measured systolic timing intervals of the plurality of different events of the cardiac cycle and the patient population data to compute an estimate of acute responsiveness to cardiac resynchronization therapy (CRT);

means for comparing the estimate to a threshold, the threshold distinguishing between acute responsiveness and non-responsiveness to CRT for a patient population; and

means for producing an indication of acute responsiveness to CRT for the pacing site in response to the comparison.