Estimating acute response to cardiac resynchronization therapy

• US 8,700,149 B2
• Filed: 05/24/2012
• Issued: 04/15/2014
• Est. Priority Date: 03/29/2007
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Patangay, Abhilash, Siejko, Krzysztof Z., Krishnan, Mohan, Carlson, Gerrard M.
• Primary Examiner(s): Koharski, Christopher D
• Assistant Examiner(s): Bays, Pamela M
• Application Number:
  US13/479,979
• Publication Number:
  US 20120232607A1
• Time in Patent Office: 691 Days
• Field of Search: 607/4, 607/9, 607/17, 607/25, 607/27, 600/509, 600/508
• US Class Current: 607/9
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/0215 by means inserted into the body catheters A61M25/00
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• 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 5/1102 Ballistocardiography
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 5/7267 involving training the classification device
• CPC Class Codes: A61B 7/00 Instruments for auscultation
• 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 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control

Abstract

Systolic timing intervals are measured in response to delivering pacing energy to a pacing site of a patient'"'"'s heart. An estimate of a patient'"'"'s acute response to cardiac resynchronization therapy (CRT) for the pacing site is determined using the measured systolic timing intervals. The estimate is compared to a threshold. The threshold preferably distinguishes between acute responsiveness and non-responsiveness to CRT for a patient population. An indication of acute responsiveness to CRT for the pacing site may be produced in response to the comparison.

Claims

1. A method, comprising:

measuring, using at least a hemodynamic sensor and another sensor, a plurality of different types of systolic timing intervals of a plurality of different events of a cardiac cycle, at least one of the systolic timing intervals based on a mechanical cardiac event;

storing patient population data;

implementing an inferential statistical fusion algorithm to combine the measured different types of systolic timing intervals of the plurality of different events of the cardiac cycle and the patient population data to compute a calculated estimate or probability of acute responsiveness to cardiac resynchronization therapy (CRT);

comparing the estimate or probability to a threshold, the threshold distinguishing between acute responsiveness and non-responsiveness to CRT for a patient population; and

producing an indication of acute responsiveness to CRT for a pacing site of a patient'"'"'s heart in response to the comparison.

2. The method of claim 1, wherein the computed calculated estimate or probability of acute responsiveness is a binary indication between acute responsiveness and non-responsiveness to CRT for the pacing cite.

3. The method of claim 1, further comprising calculating a confidence indication indicative of relative acute responsiveness to CRT for the pacing site.

4. The method of claim 3, further comprising setting an atrio-ventricular delay for the CRT based on the computed calculated estimate or probability of acute responsiveness to CRT and the confidence indication.

5. The method of claim 1, further comprising outputting a human perceivable indication indicative of the computed calculated estimate or probability of acute responsiveness to CRT.

6. The method of claim 1, wherein the systolic timing intervals are measured in response to delivery of at least one pacing pulse using one or more atrio-ventricular delay values.

7. The method of claim 1, wherein the hemodynamic sensor comprises an arteriole blood pressure sensor configured for implantation and to measure pressure of the arteriole system.

8. A method, comprising:

measuring, using a plurality of sensors, a plurality of different types of systolic timing intervals based on a plurality of cardiac events, wherein the measuring comprises detecting at least one mechanical cardiac event of a cardiac cycle;

computing a calculated estimate or probability of acute responsiveness to cardiac resynchronization therapy (CRT) for a pacing site based on an inferential statistical fusion operation performed on the plurality of different types of measured systolic timing intervals;

comparing the estimate or the probability to a threshold, the threshold distinguishing between acute responsiveness and non-responsiveness to CRT for a patient population; and

producing an indication of acute responsiveness to CRT for a pacing site of a patient'"'"'s heart in response to the comparison.

9. The method of claim 8, wherein producing the indication of acute responsiveness to CRT comprises producing a binary indication of acute responsiveness to CRT for the pacing site.

10. The method of claim 8, wherein producing the indication of acute responsiveness to CRT further comprises producing a confidence indication indicative of relative acute responsiveness to CRT for the pacing site.

11. The method of claim 10, further comprising setting an atrio-ventricular delay for the CRT based on a positive indication of acute responsiveness to CRT and the confidence indication.

12. The method of claim 8, wherein producing the indication of acute responsiveness to CRT comprises one or both of:

producing a binary indication of acute responsiveness to CRT for the pacing site; and

producing a confidence indication indicative of relative acute responsiveness to CRT for the pacing site;

the method further comprising generating a human perceivable indication of one or both of the binary indication of acute responsiveness to CRT and the confidence indication.

13. The method of claim 8, further comprising implanting an electrode of an implantable cardiac lead at the pacing site in response to a positive indication of acute responsiveness to CRT for the pacing site.

14. The method of claim 8, wherein the systolic timing intervals are measured in response to pacing the pacing site using one or more atrio-ventricular delay values.

15. The method of claim 8, wherein the systolic timing intervals are associated with mechanical activity of the patient'"'"'s heart.

16. The method of claim 8, wherein the systolic timing intervals are measured using features of signals associated with mechanical and electrical activity of the patient'"'"'s heart.

17. The method of claim 8, wherein measuring the systolic timing intervals comprises measuring timing intervals associated with heart sounds and arterial blood pressure.

18. The method of claim 8, wherein measuring the systolic timing intervals comprises measuring timing intervals associated with cardiac stroke impedance.

19. The method of claim 8, wherein the systolic timing intervals are measured in response to delivering pacing energy to the pacing site using a plurality of atrio-ventricular delay values.

20. The method of claim 8, wherein the systolic timing intervals are measured for either paced beats or unpaced beats associated with the pacing site.