Systems and methods for optimizing ventricular pacing based on left atrial electromechanical activation detected by an AV groove electrode
First Claim
1. A method for use with an implantable cardiac stimulation device equipped with a left ventricular (LV) lead having at least one proximal electrode implanted near an atrioventricular (AV) groove of the heart of the patient, the method comprising:
- sensing a left atrial (LA) cardioelectrical event using the proximal electrode of the LV lead;
detecting a corresponding LA cardiomechanical event in response to the sensed cardioelectrical event utilizing at least one of echocardiography, sonocardiography and impedance cardiography, wherein the LA cardiomechanical event corresponds to one or more of;
i) completion of an atrial kick, ii) closure of a mitral valve, and iii) onset, peak and/or completion of an A-wave of a mitral valve annulus;
determining an LA electromechanical delay between the LA cardioelectrical event and the LA cardiomechanical event;
determining pacing delays based on the LA electromechanical delay for use indelivering pacing using the lead; and
controlling pacing using the pacing delays.
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Accused Products
Abstract
Techniques are provided for use with an implantable cardiac stimulation device equipped with a multi-pole left ventricular (LV) lead having a proximal electrode implanted near an atrioventricular (AV) groove of the heart of the patient. A left atrial (LA) cardioelectrical event is sensed using the proximal electrode of the LV lead and a corresponding LA cardiomechanical event is also detected, either using an implantable sensor or an external detection system. The electromechanical activation delay between the LA cardioelectrical event and the corresponding LA cardiomechanical event is determined and then pacing delays are set based on the electromechanical activation delay for use in controlling pacing. The pacing delays can include, e.g., AV delays for use with biventricular cardiac resynchronization therapy (CRT) pacing. Other techniques described herein are directed to exploiting right atrial (RA) cardioelectrical events detected via an RA lead for the purposes of setting pacing delays.
78 Citations
29 Claims
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1. A method for use with an implantable cardiac stimulation device equipped with a left ventricular (LV) lead having at least one proximal electrode implanted near an atrioventricular (AV) groove of the heart of the patient, the method comprising:
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sensing a left atrial (LA) cardioelectrical event using the proximal electrode of the LV lead; detecting a corresponding LA cardiomechanical event in response to the sensed cardioelectrical event utilizing at least one of echocardiography, sonocardiography and impedance cardiography, wherein the LA cardiomechanical event corresponds to one or more of;
i) completion of an atrial kick, ii) closure of a mitral valve, and iii) onset, peak and/or completion of an A-wave of a mitral valve annulus;determining an LA electromechanical delay between the LA cardioelectrical event and the LA cardiomechanical event; determining pacing delays based on the LA electromechanical delay for use in delivering pacing using the lead; and controlling pacing using the pacing delays. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A system for use with an implantable cardiac stimulation device equipped with a left ventricular (LV) lead having at least one proximal electrode implanted near an atrioventricular (AV) groove of the heart of the patient, the system comprising:
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a left atrial (LA) cardioelectrical event sensor operative to sense an LA cardioelectrical event using the proximal electrode of the LV lead; an LA cardiomechanical event detector operative to detect an LA cardiomechanical event responsive to the sensed electrical event utilizing at least one of echocardiography, sonocardiography and impedance cardiography, wherein the LA cardiomechanical event corresponds to one or more of;
i) completion of an atrial kick, ii) closure of a mitral valve, and iii) onset, peak and/or completion of an A-wave of a mitral valve annulus;an LA electromechanical delay determination system operative to determine an LA electromechanical delay between the LA cardioelectrical event and the LA cardiomechanical event; an LA electromechanical delay-based pacing determination system operative to determine pacing delays based on the LA electro-mechanical delay for use in delivering pacing using the lead; and a pacing controller operative to controlling pacing using the pacing delays. - View Dependent Claims (20, 21, 22, 23, 24, 25, 26, 27, 28, 29)
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19. A system for use with an implantable cardiac stimulation device equipped with a left ventricular (LV) lead having at least one proximal electrode implanted near an atrioventricular (AV) groove of the heart of the patient, the system comprising:
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means for sensing a left atrial (LA) cardioelectrical event using the proximal electrode of the LV lead; means for detecting a LA cardiomechanical event responsive to the sensed electrical event utilizing at least one of echocardiography, sonocardiography and impedance cardiography, wherein the LA cardiomechanical event corresponds to one or more of;
i) completion of an atrial kick, ii) closure of a mitral valve, and iii) onset, peak and/or completion of an A-wave of a mitral valve annulus;means for determining an LA electromechanical delay between the LA cardioelectrical event and the LA cardiomechanical event; means for determining pacing delays based on the LA electromechanical delay for use in delivering pacing using the lead; and means for controlling pacing using the pacing delays.
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Specification