Method and apparatus for determing the coronary sinus vein branch accessed by a coronary sinus lead

• US 8,478,390 B2
• Filed: 06/04/2012
• Issued: 07/02/2013
• Est. Priority Date: 03/30/2001
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Yu, Yinghong, Ding, Jiang, Mah, Jeng, Spinelli, Julio C.
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US13/488,085
• Publication Number:
  US 20120238889A1
• Time in Patent Office: 393 Days
• Field of Search: 607 1- 30, 600/509
• US Class Current: 600/509
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• 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 1/3682 with a variable atrioventricular delay

Abstract

Systems and methods for determining the coronary sinus vein branch location of a left ventricle electrode are disclosed. The systems and methods involve detecting the occurrence of electrical events within the patient'"'"'s heart including sensing one or more of the electrical events with the electrode and then analyzing the electrical events to determine the electrode'"'"'s position. The determination of electrode position may be used to automatically adjust operating parameters of a VRT device. Furthermore, the determination of electrode position may be made in real-time during installation of the electrode and a visual indication of the electrode position may be provided on a display screen.

Claims

1. A system for determining the position of an electrode in a patient'"'"'s heart, the system comprising:

an electrode; and

a processing device configured to receive a first cardiac electrical signal representative of a first electrical event sensed by the electrode over a time window spanning a plurality of heartbeats and a second cardiac electrical signal representative of a second electrical event sensed by the electrode over the time window, and to calculate a position of the electrode in or near the heart based at least in part upon an average time interval between the first and second electrical events occurring during each heartbeat within the time window.

2. The system of claim 1, wherein the processing device is configured to determine, based on the average time interval, whether the electrode has a lateral/posterior position or an anterior position.

3. The system of claim 1, wherein the electrode is located in a coronary sinus vein branch of the left ventricle, and wherein the processing device is configured to determine, based on the average time interval, whether the electrode has a lateral/posterior vein branch position or an anterior vein branch position.

4. The system of claim 1, wherein the first electrical event comprises atrial activity and the second cardiac electrical event comprises a peak of a QRS complex at the electrode.

5. The system of claim 1, wherein the first cardiac electrical event comprises an onset of a QRS complex and the second electrical event comprises a peak of a QRS complex sensed at the electrode.

6. The system of claim 1, wherein the first electrical event comprises a peak of a right ventricle QRS complex occurring before or after the second electrical event and the second electrical event comprises a peak of a QRS sensed at the electrode.

7. The system of claim 1, wherein the processing device is configured to receive a first cardiac electrical signal from a first detection device and a second cardiac electrical signal from a second detection device.

8. The system of claim 7, further comprising a second electrode configured for positioning in an atrium area of the patient'"'"'s heart, the processing device receiving a first cardiac electrical signal from the second electrode representing the first electrical event in the atrium area of the heart prior to the processing device receiving the second cardiac electrical signal representing the second electrical event, the second electrical event comprising a left ventricle QRS complex peak.

9. The system of claim 7, further comprising a second electrode configured for positioning in a right ventricle area of the patient'"'"'s heart, the processing device receiving a first cardiac electrical signal from the second electrode representing the first electrical event in the right ventricle before or after the processing device receiving the second cardiac electrical signal representing the second electrical event, the second electrical event comprising a left ventricle QRS complex peak.

10. The system of claim 1, further comprising a means for adjusting one or more settings of a VRT device based on a determined position of the electrode.

11. A system for determining the position of an electrode in a patient'"'"'s heart, the system comprising:

an electrode; and

a processing device configured to receive a first cardiac electrical signal representative of a first electrical event sensed repeatedly by the electrode over a time window spanning a plurality of heartbeats and a second cardiac electrical signal representative of a second electrical event repeatedly sensed by the electrode over the time window, and to calculate a position of the electrode in or near the heart based at least in part upon a comparison of an average time interval between the first and second electrical events during each heartbeat within the time window to a threshold value; and

wherein the processing device is configured to determine, based on the average time interval, whether the electrode has a lateral/posterior position or an anterior position.

12. The system of claim 11, wherein the electrode is located in a coronary sinus vein branch of the left ventricle, and wherein the processing device is configured to determine, based on the average time interval, whether the electrode has a lateral/posterior vein branch position or an anterior vein branch position.

13. The system of claim 11, wherein the first electrical event comprises atrial activity and the second cardiac electrical event comprises a peak of a QRS complex at the electrode.

14. The system of claim 11, wherein the first cardiac electrical event comprises an onset of a QRS complex and the second electrical event comprises a peak of a QRS complex sensed at the electrode.

15. The system of claim 11, wherein the first electrical event comprises a peak of a right ventricle QRS complex occurring before or after the second electrical event and the second electrical event comprises a peak of a QRS sensed at the electrode.

16. The system of claim 11, wherein the processing device is configured to receive a first cardiac electrical signal from a first detection device and a second cardiac electrical signal from a second detection device.

17. A method for determining a position of an electrode located in a ventricle area of a patient'"'"'s heart, the method comprising:

detecting a first depolarization for each of a plurality of intracardiac depolarization wavefronts sensed by the electrode over a time window spanning a plurality of heartbeats;

detecting a second depolarization event for each of the plurality of intracardiac depolarization wavefronts sensed by the electrode over the time window;

measuring a plurality of first time intervals between the first depolarization event and the second depolarization event occurring during each heartbeat within the time window;

computing an average time interval based on the first time intervals measured over the time window; and

determining from the average time interval whether the electrode has a lateral/posterior position or an anterior position within the ventricle area.

18. The method of claim 17, wherein determining whether the electrode has a lateral/posterior position or an anterior position within the ventricle area comprises comparing the average time interval to a threshold value and determining a lateral/posterior position when the average time interval is greater than the threshold value.

19. The method of claim 17, wherein detecting the first depolarization event comprises sensing a peak or onset of a QRS complex.

20. The method of claim 17, wherein detecting the second depolarization event comprises sensing a peak or onset of a QRS complex.