Monitoring hemodynamic status based on intracardiac or vascular impedance

• US 8,241,222 B2
• Filed: 10/31/2008
• Issued: 08/14/2012
• Est. Priority Date: 07/31/2008
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Zielinski, Todd M., Hettrick, Douglas A., Rouw, Mattias
• Primary Examiner(s): Yu, Melanie J
• Assistant Examiner(s): Crawford, Erik B
• Application Number:
  US12/262,941
• Publication Number:
  US 20100030086A1
• Time in Patent Office: 1,383 Days
• Field of Search: 600/506, 600/521, 600/547, 607/23
• US Class Current: 600/506
• CPC Class Codes: A61B 5/021 Measuring pressure in heart or blood vessels A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/02158 provided with two or more sensor elements
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• 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 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36564 controlled by blood pressure

Abstract

This disclosure relates to monitoring intracardiac or vascular impedance to determine a change in hemodynamic status by detecting changes in an impedance parameter over cardiac cycles. An example method includes measuring a plurality of impedance values of a path within a patient over time, wherein the path includes at least one blood vessel or cardiac chamber of the patient, and wherein the impedance values vary as a function of blood pressure within the at least one vessel or chamber, determining a plurality of values of an impedance parameter over time based on the measured impedance values, wherein each of the impedance parameter values is determined based on a respective sub-plurality of the impedance values, comparing at least one of the impedance parameter values to at least one prior impedance parameter value, and identifying a change in a cardiovascular parameter related to the blood pressure based on the comparison.

Claims

1. A method comprising:

measuring a plurality of impedance values of a path within a patient over time, wherein the path includes at least one blood vessel or cardiac chamber of the patient, and wherein the impedance values vary as a function of blood pressure within the at least one vessel or chamber;

determining a plurality of values of an impedance parameter over time based on the measured impedance values, wherein each of the impedance parameter values is determined based on a respective sub-plurality of the impedance values, determining the plurality of values of the impedance parameter comprising

identifying an R-wave for a current cardiac cycle,

identifying a maximum impedance and a minimum impedance for the current cardiac cycle,

determining a first time interval between the R-wave and the minimum impedance,

determining a second time interval between the R-wave and the maximum impedance, and

determining a ratio of the first time interval and the second time interval;

comparing the ratio of the current cardiac cycle to a ratio of a prior cardiac cycle; and

identifying a change in a cardiovascular parameter related to the blood pressure based on the comparison.

2. The method of claim 1, further comprising triggering an alert in response to the change in the cardiovascular parameter.

3. The method of claim 1, further comprising modifying a therapy delivered to the patient in response to the change in the cardiovascular parameter.

4. The method of claim 1, wherein determining a plurality of values of an impedance parameter further comprises identifying a fiducial point of the plurality of impedance values for the current cardiac cycle, and determining a third time interval between the R-wave and the fiducial point, and

comparing the third time interval for the current cardiac cycle to a third time interval for a previous cardiac cycle.

5. A non-transitory computer-readable medium comprising instructions for causing a programmable processor to:

measure a plurality of impedance values of a path within a patient over time, wherein the path includes at least one blood vessel or cardiac chamber of the patient, and wherein the impedance values vary as a function of blood pressure within the at least one vessel or chamber;

determine a plurality of values of an impedance parameter over time based on the measured impedance values, wherein each of the impedance parameter values is determined based on a respective sub-plurality of the impedance values, wherein the instructions for causing the programmable processor to determine the plurality of values of the impedance parameter comprise instructions that cause the programmable processor to;

identify an R-wave for a current cardiac cycle,

identify a minimum impedance and a maximum impedance for the current cardiac cycle,

determine a first time interval between the R-wave and the minimum impedance,

determine a second time interval between the R-wave and the maximum impedance, and

determine a ratio of the first time interval and the second time interval;

compare the ratio of the current cardiac cycle to a ratio of a prior cardiac cycle;

identify a change in a cardiovascular parameter related to the blood pressure based on the comparison; and

execute a programmed response upon identifying a change in the cardiovascular parameter.