Method and apparatus for optimization of cardiac resynchronization therapy using vectorcardiograms derived from implanted electrodes

• US 9,248,294 B2
• Filed: 09/11/2013
• Issued: 02/02/2016
• Est. Priority Date: 09/11/2013
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Engels, Elien, Hernandez, Alfonso Aranda, Prinzen, Frits W
• Primary Examiner(s): Gedeon, Brian T
• Application Number:
  US14/023,791
• Publication Number:
  US 20150073286A1
• Time in Patent Office: 874 Days
• Field of Search: None
• US Class Current: 1/1
• CPC Class Codes: A61B 5/341 Vectorcardiography [VCG]
• 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 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/36507 controlled by gradient or slope of the heart potential
• 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 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation

Abstract

A cardiac resynchronization pacemaker and a method of adjusting the pacemaker. The method includes deriving a vectorcardiogram from implanted electrodes (D-VCG), analyzing the D-VCG, deriving optimal CRT pacing parameters from the analysis of the D-VCG, and adjusting the CRT pacemaker according to the derived parameters. The pacemaker may include a processor configured to perform the method.

Claims

1. A method of adjusting a cardiac resynchronization (CRT) pacemaker of the type having the capabilities of left ventricular pacing and atrial sensing, comprising:

automatically deriving a vectorcardiogram from implanted electrodes (D-VCG) by a processor of the pacemaker;

analyzing the D-VCG by the processor;

deriving optimal CRT pacing parameters from the analysis of the D-VCG; and

adjusting the CRT pacemaker according to the derived parameters; and

employing the obtained D-VCG to detect loss of capture, due to technical failure of the pacemaker or lead, irregular heart beats or altering cardiac conduction properties.

2. A method according to claim 1 further comprising storage of the D-VCG for diagnostic purposes.

3. A method according to claim 1, wherein the derived pacing parameters include an atrial to left ventricular (A-LV) and an atrial to right ventricular (A-RV) pacing interval.

4. A method according to claim 1, wherein the derived pacing parameters include an atrial to left ventricular (A-LV) pacing interval.

5. A method according to claim 1 wherein the derived parameters include an optimal electrode location.

6. A method according to claim 1 wherein the analysis of the D-VCG comprises measurement of QRS vector area (QRSVarea).

7. A method according to claim 6 wherein the optimal pacing parameters comprise those that result in a minimum QRSVarea.

8. A method according to claim 1 wherein the analysis of the D-VCG comprises measurement of QRS vector perimeter.

9. A method according to claim 1 wherein the analysis of the D-VCG comprises measurement of QRS vector amplitude.

10. A method according to claim 1 wherein analysis of the D-VCGs comprises identification of start and endpoints of QRS complexes.

11. A method according to claim 1 wherein the analysis of D-VCGs comprises performing the analysis in conjunction with delivery of CRT pacing using different pacing parameters.

12. A method according to claim 1 wherein the analysis of D-VCGs comprises performing the analysis in conjunction with delivery of CRT pacing using different pacing electrode configurations.

13. A cardiac resynchronization (CRT) pacemaker of the type having the capabilities of left ventricular pacing and atrial sensing, and comprising a set of implanted electrodes, comprising:

a processor configured to;

a) derive a vectorcardiogram from the implanted electrodes (D-VCG);

b) analyze the D-VCG;

c) derive optimal CRT pacing parameters from the analysis of the D-VCG; and

d) control delivery of CRT pacing according to the derived parameters;

wherein the processor is further configured to derive the D-VCG by;

determining a first axis signal of the D-VCG between a first electrode and a second electrode of the set of implanted electrodes; and

determining a second axis signal of the D-VCG between a third electrode and a fourth electrode of the set of implanted electrodes;

wherein the processor is configured to analyze the D-VCG by computing a QRS parameter using the first axis signal and the second axis signal; and

wherein the processor is further configured to derive the D-VCG by

determining a first vector signal between the first electrode and a fifth electrode of the set of implanted electrodes;

determining a second vector signal between the third electrode and the fifth electrode; and

determining a third axis of the D-VCG as a combination of the first vector signal and the second vector signal; and

wherein the processor is configured to analyze the D-VCG by computing the QRS parameter using the first axis signal, the second axis signal and the third axis signal.

14. A CRT pacemaker according to claim 13 further comprising memory configured to store the D-VCG for diagnostic purposes.

15. A CRT pacemaker according to claim 13, wherein the derived pacing parameters include an atrial to left ventricular (A-LV) and an atrial to right ventricular (A-RV) pacing interval.

16. A CRT pacemaker according to claim 13, wherein the derived pacing parameters include an atrial to left ventricular (A-LV) pacing interval.

17. A CRT pacemaker according to claim 13 wherein the derived parameters include an optimal electrode location.

18. A CRT pacemaker according to claim 13 wherein the analysis of the D-VCG comprises measurement of QRS vector area (QRSVarea).

19. A CRT pacemaker according to claim 18 wherein the optimal pacing parameters comprise those that result in a minimum QRSVarea.

20. A CRT pacemaker according to claim 13 wherein the analysis of the D-VCG comprises measurement of QRS vector perimeter.

21. A CRT pacemaker according to claim 13 wherein the analysis of the D-VCG comprises measurement of QRS vector amplitude.

22. A CRT pacemaker according to claim 13

wherein analysis of the D-VCGs comprises identification of start and endpoints of QRS complexes.

23. A CRT pacemaker according to claim 13 wherein the analysis of D-VCGs comprises performing the analysis in conjunction with delivery of CRT pacing using different pacing parameters.

24. A CRT pacemaker according to claim 13 wherein the analysis of D-VCGs comprises performing the analysis in conjunction with delivery of CRT pacing using different pacing electrode configurations.

25. A cardiac resynchronization (CRT) pacemaker of the type having the capabilities of left ventricular pacing and atrial sensing, and comprising a set of implanted electrodes, comprising:

a processor configured to;

a) derive a vectorcardiogram from the implanted electrodes (D-VCG);

b) analyze the D-VCG;

c) derive optimal CRT pacing parameters from the analysis of the D-VCG; and

d) control delivery of CRT pacing according to the derived parameters; and

employing the obtained D-VCG to detect loss of capture, due to technical failure of the pacemaker or lead, irregular heart beats or altering cardiac conduction properties.