Cardiac resynchronization system employing mechanical measurement of cardiac walls

• US 8,792,980 B2
• Filed: 12/29/2010
• Issued: 07/29/2014
• Est. Priority Date: 12/05/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Yu, Yinghong, Ding, Jiang, Zhu, Qingsheng
• Primary Examiner(s): Schaetzle, Kennedy
• Application Number:
  US12/980,417
• Publication Number:
  US 20110093031A1
• Time in Patent Office: 1,308 Days
• US Class Current: 607/9
• 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 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium

Abstract

Methods and devices are disclosed for employing mechanical measurements to synchronize contractions of ventricular wall locations. Accelerometers that may be placed within electrode leads are positioned at ventricular wall locations, such as the left ventricle free wall, right ventricle free wall, and the anterior wall/septum wall. The accelerometers produce signals in response to the motion of the ventricular wall locations. A processor may then compare the signals to determine a difference in the synchronization of the ventricular wall location contractions. The difference in synchronization can be determined in various ways such as computing a phase difference and/or amplitude difference between the accelerometer signals. One or more stimulation pulses may be provided per cardiac cycle to resynchronize the contractions as measured by the accelerometers to thereby constantly and automatically optimize the cardiac resynchronization therapy.

Claims

1. A method comprising:

sensing motion of a heart contraction at a first heart to produce a first signal;

sensing motion of the heart contraction at a second heart wall location to produce a second signal;

comparing the first signal to the second signal to detect a difference in synchronization of the first heart wall location with respect to the second heart wall location; and

iteratively adjusting a control parameter of a stimulation pulse to reduce the difference in synchronization.

2. The method of claim 1, wherein comparing the first signal to the second signal comprises comparing at least one of an amplitude, a time of peak contraction, or a time of an onset of contraction indicated by the first signal with respect to a corresponding measurement indicated by the second signal.

3. The method of claim 1, wherein iteratively adjusting the control parameter comprises:

determining a magnitude of the difference in synchronization of the first heart wall location with respect to the second heart wall location; and

adjusting the control parameter based on the magnitude determined.

4. The method of claim 3, wherein the determining the magnitude and adjusting the control parameter based on the magnitude arc performed until the difference in synchronization is within an acceptable threshold of dyssynchrony,

5. The method of claim 1, wherein iteratively adjusting the control parameter comprises using a root finding function.

6. The method of claim 5, wherein the root finding function is a bisection method.

7. The method of claim 1, wherein the difference in synchronization comprises a phase difference, and wherein iteratively adjusting the control parameter comprises:

identifying a stimulation parameter by referencing a pre-established relationship between the phase difference and the stimulation parameter; and

adjusting the control parameter using the stimulation parameter.

8. A machine-readable storage medium comprising instructions, which when executed by a machine, cause the machine to:

sense motion of a heart contraction at a first heart wall location to produce a first signal;

sense motion of the heart contraction at a second heart wall location to produce a second signal;

compare the first signal to the second signal to detect a difference in synchronization of the first heart wall location with respect to the second heart wall location; and

iteratively adjust a control parameter of a stimulation pulse to reduce the difference in synchronization.

9. The machine-readable storage medium of claim 8, wherein the instructions to compare the first signal to the second signal comprise instructions, which when executed on the machine, cause the machine to compare at least one of an amplitude, a time of peak contraction, or a time of an onset of contraction indicated by the first signal with respect to a corresponding measurement indicated by the second signal.

10. The machine-readable storage medium of claim 8, wherein the instructions to iteratively adjust the control parameter comprise instructions, which when executed on the machine, cause the machine to:

determine a magnitude of the difference in synchronization of the first heart wall location with respect to the second heart wall location; and

adjust the control parameter based on the magnitude determined.

11. The machine-readable storage medium of claim 10, wherein the instructions to determine the magnitude and adjust the control parameter based on the magnitude are performed until the difference in synchronization is within an acceptable threshold of dyssynchrony.

12. The machine-readable storage medium of claim 8, wherein the instructions to iteratively adjust the control parameter comprise instructions, which when executed on the machine, cause the machine to use a root finding function.

13. The machine-readable storage medium of claim 12, wherein the root finding function is a bisection method.

14. The machine-readable storage medium of claim 8, wherein the difference in synchronization comprises a phase difference, and wherein the instructions to iteratively adjust the control parameter comprise instructions, which when executed on the machine, cause the machine to:

identify a stimulation parameter by referencing a pre-established relationship between the phase difference and the stimulation parameter; and

adjust the control parameter using the stimulation parameter.

15. An apparatus comprising:

a first motion sensor located at a first heart wall location and configured to produce a first signal;

a second motion sensor located at a second heart wall location and configured to produce a second signal;

a processor, coupled to the first and second motion sensors, the processor configured to;

compare the first signal to the second signal to detect a difference in synchronization of the first heart wall location with respect to the second heart watt location; and

iteratively adjust a control parameter of a stimulation pulse to reduce the difference in synchronization.

16. The apparatus of claim 15, wherein the processor is configured to:

determine a magnitude of the difference in synchronization of the first heart wall location with respect to the second heart wall location; and

adjust the control parameter based on the magnitude determined.

17. The apparatus of claim 16, wherein the processor is configured to determine the magnitude and adjust the control parameter based on the magnitude until the difference in synchronization is within an acceptable threshold of dyssynchrony.

18. The apparatus of claim 15, wherein the processor is configured to use a root finding function to iteratively adjust the control parameter.

19. The apparatus of claim 18, wherein the root finding function is a bisection method.

20. The apparatus of claim 15, wherein the difference in synchronization comprises a phase difference, and wherein the processor is configured to iteratively adjust the control parameter by:

identifying a stimulation parameter by referencing a pre-established relationship between the phase difference and the stimulation parameter; and

adjusting the control parameter using the stimulation parameter.