CRM-device ventricular-pacing blanking control

• US 8,548,588 B1
• Filed: 09/21/2012
• Issued: 10/01/2013
• Est. Priority Date: 09/21/2012
• Status: Active Grant

• Current Assignee: Inovise Medical, Inc.
• Original Assignee: Inovise Medical, Inc.
• Inventors: Bauer, Peter T.
• Primary Examiner(s): Wieland, Robert N
• Application Number:
  US13/624,679
• Time in Patent Office: 375 Days
• Field of Search: 607/18, 607/4, 607/5, 607/17, 607/27, 600/513
• US Class Current: 607/18
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 7/023 for introduction into the body, e.g. into the oesophagus oesophageal ECG probes A61B5/285
• CPC Class Codes: A61B 7/04 Electric stethoscopes microphones, acoustic transducers therefor H04R
• CPC Class Codes: A61B 7/045 Detection of Korotkoff sounds A61B5/0225 takes precedence; measuring blood pressure A61B5/021
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone

Abstract

A system, operatively connectable both to a cardiac-rhythm-management (CRM) subject, and to a CRM device associated with that subject, and an associated method, operable, in relation to received-and-processed, real-time, CRM-subject-specific, simultaneous ECG and heart-sound information, and other information including measurement time markers where available, for blocking, under all circumstances during the ventricular relative refractory period lying within each of successive CRM-subject cardiac cycles occupying a span of such cycles, the ventricular pacing activity of the subject-associated CRM device—the beginning and ending of such blocking in each cardiac cycle being system-defined to lie preferably, and respectively, (a) within the real-time, ventricular depolarization window in the cycle, and (b) at the time of the real-time, S2 heart-sound, plus or minus any user-defined time-delta.

Claims

1. A computer-based system for blocking the ventricular pacing activity of a CRM subject'"'"'s associated with CRM device so as to assure such blocking during the entirety of the ventricular relative refractory period in each of the CRM subject'"'"'s cardiac cycles—

with the beginning and the ending of the overall period of such blocking in each cardiac cycle being system-defined to lie, respectively, (a) within the real-time, ventricular depolarization window in the cycle, and (b) at the time of the real-time, S2 heart-sound, plus or minus any user-defined time-delta, said system comprising

a signal-processing structure having information input structure adapted to receive, for processing, real-time, cardiac-cycle-specific ECG and heart-sound information derived from such a CRM subject, and an output for supplying processed ECG and heart-sound information, and

control-signal-generating structure disposed downstream from said signal-processing structure, including an input operatively connected to said output for receiving processed information therefrom, and for generating, in relation to such received, processed information, a CRM pacing control signal designed to effect CRM-device pacing-activity blocking during the mentioned overall period of such blocking.

2. The system of claim 1, which is at least partially integrated with the CRM subject'"'"'s associated CRM device.

3. The system of claim 1 which is constructed whereby the beginning of blocking associated with the mentioned overall period of blocking occurs at the onset of ventricular depolarization.

4. The system of claim 1 which is constructed whereby the beginning of blocking associated with the mentioned overall period of blocking occurs adjacent the peak of the R-wave.

5. The system of claim 1 which is constructed whereby the beginning of blocking associated with the mentioned overall period of blocking occurs at the time of the S1 heart sound.

6. The system of claim 1 which is constructed whereby the beginning of blocking associated with the mentioned overall period of blocking occurs adjacent the conclusion of the ventricular depolarization window.

7. The system of claim 1, wherein said signal-processing and control-signal-generating structures are constructed to establish plural-cycle-group pacing blocking based upon averaged information drawn from, and signal processed by these two system structures in relation to, system-received cardiac-cycle information associated with plural, CRM-subject-specific cardiac cycles that are present in selected, successive, plural-cycle groups of CRM-subject-specific cardiac cycles.

8. A signal-processing method employable in preparation for per-cardiac-cycle blanking of the ventricular pacing operation of a CRM subject'"'"'s associated CRM device during a blanking time interval within each of the CRM subject'"'"'s cardiac cycles, which interval always includes the entirety of the ventricular relative refractory period in the cycle, said method including the steps of

generating, and then making available for potential application to the CRM subject'"'"'s associated CRM device, a ventricular-pacing blanking-time CRM control signal which, through appropriate method-implemented signal processing of received, real-time, CRM-subject-specific, simultaneous ECG and heart-sound information, has been established with a duration possessing a beginning and an ending defined to lie, respectively, (a) within the real-time, ventricular depolarization window in the cycle, and (b) at the time of the real-time, S2 heart-sound, plus or minus any user-defined time-delta.

9. The method of claim 8 wherein said generating is performed whereby the beginning of ventricular-pacing blanking occurs at the onset of ventricular depolarization.

11. The method of claim 8 wherein said generating is performed whereby the beginning of ventricular-pacing blanking occurs at the time of the S1 heart sound.

12. The method of claim 8 wherein said generating is performed whereby the beginning of ventricular-pacing blanking occurs adjacent the conclusion of the ventricular depolarization window.

13. The method of claim 8 which involves plural-cycle-group pacing blanking based upon averaged information drawn from, and signal processed in relation to, cardiac-cycle information associated with plural, CRM-subject-specific cardiac cycles that are present in selected, successive, plural-cycle groups of CRM-subject-specific cardiac cycles.

10. The method of clam 8 wherein said generating is performed whereby the beginning of ventricular-pacing blanking occurs adjacent the peak of the R-wave.

14. A signal-processing method useable in relation (a) to a cardiac-rhythm-management (CRM) subject equipped with a CRM device, and (b) to the availability of real-time, simultaneous, CRM-subject-specific, ECG and heart-sound information, implementable during a period embracing a plurality of successive, CRM-subject cardiac cycles for assuring, during each of those cycles, that no CRM-device-initiated, ventricular pacing pulse may be delivered to the CRM subject within a blanking-time control duration in the cycle which extends from adjacent the onset of the electromechanical systole in the cycle to adjacent a point in time disposed effectively at the end of the cycle'"'"'s ventricular relative refractory period, said method comprising

during the mentioned period of successive cycles, and on a per-cycle basis, receiving the mentioned, simultaneous ECG and heart-sound information,

employing signal processing, producing, from such per-cycle received information, selected, associated, noted information, including (a) the associated time span of the electromechanical (EM) systole, and (b) the associated times of selected, ECG and heart-sound fiducial markers, lying within the ventricular depolarization window in the EM systole,

on a per-cycle basis, and based upon said producing, generating a CRM control signal which lasts throughout the mentioned blanking-time control duration, and

following said generating, making a so-generated CRM control signal available for application to the CRM subject'"'"'s associated CRM device for preventing ventricular pacing-pulse delivery by the device during the next, successive cardiac cycle.

15. A signal-processing method useable in relation (a) to a cardiac-rhythm-management (CRM) subject equipped with a CRM device, and (b) to the availability of real-time, simultaneous, CRM-subject-specific, ECG and heart-sound information, implementable during a period embracing a plurality of successive, CRM-subject cardiac cycles for assuring, during each of those cycles, that not CRM-device-initiated, ventricular pacing pulse may be delivered to the CRM subject within a blanking-time control duration in the cycle which extends from adjacent the onset of the electromechanical systole in the cycle to adjacent a point in time disposed effectively at the end of the cycle'"'"'s ventricular relative refractory period, said method comprising

during the mentioned period of successive cycles, and on a per-cycle basis, receiving the mentioned, simultaneous ECG and heart-sound information,

employing signal processing, producing, from such per-cycle received information, selected, associated, noted information, including (a) the associated time span of the electromechanical (EM) systole, and (b) the associated times of selected, ECG and heart-sound fiducial markers, lying within the ventricular depolarization window in the EM systole,

averaging the time information associated with the noted information relating to a selected group of cardiac cycles, and thereby establishing available, noted, average information for the selected group,

supplying the established, available, noted average information to a signal generator,

generating, by operation of the signal generator, and in relation to the established, available, noted average information, a CRM control signal which lasts throughout the mentioned blanking-time control duration,

following said generating, making the generated CRM control signal available for application to the CRM subject'"'"'s associated CRM device for preventing ventricular pacing-pulse delivery by the device during a next, like succession of CRM-subject cardiac cycles, and

recurrently repeating the recited receiving, producing, averaging, supplying, generating, marking-available and repeating steps.