Implantable medical device and method for monitoring synchronicity of the ventricles of a heart
First Claim
1. An implantable medical device for monitoring ventricular synchrony of a heart of patient including a pace pulse generator adapted to produce cardiac stimulating pacing pulses and being connectable to at least one medical lead for delivering bi-ventricular pulses to cardiac tissue of said heart, comprising:
- an impedance measuring unit that during impedance measuring sessions, measures an impedance signal using an electrode configuration, said configuration being connectable to said impedance measuring unit and interacting with said patient;
a notch detecting unit that detects an occurrence of a notch in the impedance signal coincident with a period including a change from rapid to slow filling of a ventricle, said notch being indicated by a first positive slope change in a negative slope in a predetermined time window during a diastolic phase of a cardiac cycle, wherein a portion of the impedance signal within a time window surrounding said notch being a notch impedance curve;
a notch feature determining unit that determines a notch feature using said notch impedance curve;
a synchronicity determining unit that determines a degree of synchronicity based on said notch feature, wherein a decreasing notch feature indicates an increased degree of synchronicity in the filling phase of the ventricles; and
a VV delay determining unit adapted to perform an optimization procedure, and wherein said pace pulse generator is controlled to, based on said notch feature, iteratively adjust a VV-interval so as to minimize said notch feature to obtain substantially synchronized ventricle contractions.
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Abstract
In an implantable medical device and a method for monitoring ventricular synchronicity of a heart. In particular, impedance signals are measured and an occurrence of a notch is detected in the impedance signal coincident with a period including a change from rapid to slow filling of a ventricle. The notch is indicated by a first positive slope change in a negative slope in a predetermined time window during a diastolic phase of a cardiac cycle. A degree of synchronicity is determined based on the notch feature, wherein a decreasing notch feature indicates an increased degree of synchronicity in the filling phase of the ventricles.
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Citations
27 Claims
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1. An implantable medical device for monitoring ventricular synchrony of a heart of patient including a pace pulse generator adapted to produce cardiac stimulating pacing pulses and being connectable to at least one medical lead for delivering bi-ventricular pulses to cardiac tissue of said heart, comprising:
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an impedance measuring unit that during impedance measuring sessions, measures an impedance signal using an electrode configuration, said configuration being connectable to said impedance measuring unit and interacting with said patient; a notch detecting unit that detects an occurrence of a notch in the impedance signal coincident with a period including a change from rapid to slow filling of a ventricle, said notch being indicated by a first positive slope change in a negative slope in a predetermined time window during a diastolic phase of a cardiac cycle, wherein a portion of the impedance signal within a time window surrounding said notch being a notch impedance curve; a notch feature determining unit that determines a notch feature using said notch impedance curve; a synchronicity determining unit that determines a degree of synchronicity based on said notch feature, wherein a decreasing notch feature indicates an increased degree of synchronicity in the filling phase of the ventricles; and a VV delay determining unit adapted to perform an optimization procedure, and wherein said pace pulse generator is controlled to, based on said notch feature, iteratively adjust a VV-interval so as to minimize said notch feature to obtain substantially synchronized ventricle contractions. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
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13. A method for monitoring ventricular synchrony of a heart of a patient in an implantable medical device including a pace pulse generator that emits cardiac stimulating pacing pulses and is connectable to at least one medical lead for delivering bi-ventricular pulses to cardiac tissue of said heart, comprising:
- during impedance measuring sessions, measuring an impedance signal using an electrode configuration being connectable to an impedance measuring unit and interacting with said patient, and generating a corresponding impedance signal;
detecting an occurrence of a notch in the impedance signal coincident with a period including a change from rapid to slow filling of a ventricle, said notch being indicated by a first positive slope change in a negative slope in a predetermined time window during a diastolic phase of a cardiac cycle, wherein a portion of the impedance signal within the time window surrounding said notch being a notch impedance curve; determining a notch feature using said notch impedance curve; determining a degree of synchronicity based on said notch feature, wherein a decreasing notch feature indicates an increased degree of synchronicity in the filling phase of the ventricles; and performing an optimization procedure based on said notch feature by iteratively adjusting a VV-interval so as to minimize said notch feature to obtain substantially synchronized ventricle contractions. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24)
- during impedance measuring sessions, measuring an impedance signal using an electrode configuration being connectable to an impedance measuring unit and interacting with said patient, and generating a corresponding impedance signal;
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25. A method for optimizing lead and/or electrode locations, said comprising a plurality of electrodes being connectable to an implantable medical device comprising a pace pulse generator that emits cardiac stimulating pacing pulses and is connectable to at least one medical lead for delivering stimulation pulses to cardiac tissue of a heart, comprising:
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a) measuring an impedance signal at a first electrode configuration, wherein the electrodes of said electrode configuration are connectable to said implantable medical device and are located at a right side of said heart; b) detecting an occurrence of a notch in the impedance signal coincident with a period including a change from rapid to slow filling of a ventricle, said notch being indicated by a first positive slope change in a negative slope in a predetermined time window during a diastolic phase of a cardiac cycle, wherein a portion of the impedance signal within the time window surrounding said notch being a notch impedance curve; c) determining a notch feature using said notch impedance curve for said electrode configuration; d) determining a degree of synchronicity based on said notch feature for said electrode configuration, wherein a decreasing notch feature indicates an increased degree of synchronicity in the filling phase of the ventricles; e) performing an optimization procedure based on said notch feature by iteratively adjusting a VV-interval so as to minimize said notch feature in said predetermined time window for said first electrode configuration to determine a minimum notch feature; f) repeating (a)-(e) for at least a second electrode configuration; g) comparing said minimum notch feature for each configuration to identify an overall minimum notch feature; and h) selecting the electrode configuration being associated with the minimum notch feature.
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26. A system for optimizing lead and/or electrode locations including a plurality of electrodes and an implantable medical device, said system comprising:
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at least one medical lead arrangement comprising said plurality of electrodes in an electrode configuration; a pace pulse generator that produces cardiac stimulating pacing pulses and is connected to said at least one medical lead arrangement for delivering stimulation pulses to cardiac tissue of a heart of a patient; an impedance measuring unit that, during impedance measuring sessions, measures an impedance signal obtained at the electrode configuration connected to said impedance measuring unit and interacting with said patient, wherein the electrodes of said electrode configuration are located at a right side of said heart; a notch detecting unit that detects an occurrence of a notch in the impedance signal coincident with a period including a change from rapid to slow filling of a ventricle, said notch being indicated by a first positive slope change in a negative slope in a predetermined time window during a diastolic phase of a cardiac cycle, wherein a portion of the impedance signal within a time window surrounding said notch being a notch impedance curve; a notch feature determining unit that determines a notch feature using said notch impedance curve; a synchronicity determining unit that determines a degree of synchronicity based on said notch feature; and an external control unit in connection with said implantable medical device and being configured to; instruct said implantable medical device to obtain a notch feature for at least a second electrode configuration; compare said notch feature for each configuration to identify a minimum notch feature; and select the electrode configuration being associated with the minimum notch feature.
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27. A pacing analyzer for optimizing lead and/or electrode locations being connectable to at least one medical lead implantable in a heart of a patient and defining at least one medical lead arrangement comprising electrodes in an electrode configuration, said analyzer comprising:
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a pace pulse generator that emits cardiac stimulating pacing pulses and connected to said at least one medical lead arrangement for delivering stimulation pulses to cardiac tissue of a heart of a patient; an impedance measuring unit that, during impedance measuring sessions, measures an impedance signal obtained at the electrode configuration connected to said impedance measuring unit and interacting with said patient, wherein the electrodes of said electrode configuration are located at a right side of said heart; a notch detecting unit that detects an occurrence of a notch in the impedance signal coincident with a period including a change from rapid to slow filling of a ventricle, said notch being indicated by a first positive slope change in a negative slope in a predetermined time window during a diastolic phase of a cardiac cycle, wherein a portion of the impedance signal within a time window surrounding said notch being a notch impedance curve; a notch feature determining unit that determines a notch feature using said notch impedance curve; a synchronicity determining unit that determines a degree of synchronicity based on said notch feature, wherein a decreasing notch feature indicates an increased degree of synchronicity in the filling phase of the ventricles; a VV delay determining unit that executes an optimization procedure, wherein said pace pulse generator is controlled to, based on said notch feature, iteratively adjust a VV-interval so as to minimize said notch feature in said predetermined time window to determine a minimum notch feature; and a control unit configured to; compare said minimum notch feature for different electrode and/or lead configurations to identify an overall minimum notch feature; and indicate the electrode configuration being associated with the overall minimum notch feature.
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Specification