Systems and methods for ranking and selection of pacing vectors

• US 9,393,426 B2
• Filed: 10/22/2014
• Issued: 07/19/2016
• Est. Priority Date: 07/02/2009
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Siejko, Krzysztof Z., Shome, Shibaji, Ding, Jiang
• Primary Examiner(s): Flory, Christopher A
• Application Number:
  US14/520,559
• Publication Number:
  US 20150039044A1
• Time in Patent Office: 636 Days
• Field of Search: 607/9, 607/27, 607/28, 600/509, 600/512
• US Class Current: 1/1
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• CPC Class Codes: A61N 1/36185 Selection of the electrode configuration
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/3704 Circuits specially adapted therefor, e.g. for sensitivity control
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation

Abstract

Approaches to rank potential left ventricular (LV) pacing vectors are described. Early elimination tests are performed to determine the viability of LV cathode electrodes. Some LV cathodes are eliminated from further testing based on the early elimination tests. LV cathodes identified as viable cathodes are tested further. Viable LV cathode electrodes are tested for hemodynamic efficacy. Cardiac capture and phrenic nerve activation thresholds are then measured for potential LV pacing vectors comprising a viable LV cathode electrode and an anode electrode. The potential LV pacing vectors are ranked based on one or more of the hemodynamic efficacy of the LV cathodes, the cardiac capture thresholds, and the phrenic nerve activation thresholds.

Claims

1. A method of programming a cardiac device, comprising:

receiving input through a user interface, wherein the input is utilized for, at least in part, a selection of a plurality of cardiac electrodes for testing as potential Left Ventricular (LV) pacing vectors;

measuring a value of a parameter indicating hemodynamic function of pacing for the selected plurality of cardiac electrodes;

eliminating one or more cardiac electrodes from a set of viable cardiac electrodes according to the parameter indicating hemodynamic function, wherein further testing is performed only on the set of viable cardiac electrodes;

measuring one or both of a cardiac capture threshold and a phrenic nerve activation threshold for the set of viable cardiac electrodes; and

programming the cardiac device to deliver therapy using the LV pacing vectors based on the one or both measured cardiac capture threshold and phrenic nerve activation threshold.

2. The method of claim 1, further comprising:

wherein eliminating one or more cardiac electrodes from the set of viable electrodes includes eliminating a first cardiac electrode from the set of viable cardiac electrodes according to the parameter indicating hemodynamic function and eliminating a second cardiac electrode from the set of viable cardiac electrodes according to the proximity of the second cardiac electrode to the first cardiac electrode.

3. The method of claim 1, further comprising ranking potential LV pacing vectors in a first tier and one or more additional tiers, at least one tier ranking viable LV cardiac electrodes based on the measured value of the hemodynamic function parameter and at least another tier ranking the potential LV pacing vectors based on a difference between the cardiac capture threshold and the phrenic nerve activation threshold.

4. The method of claim 3, further comprising measuring one or both of a signal amplitude and a pacing impedance for each of the potential LV pacing vectors, wherein ranking the potential LV pacing vectors further comprises ranking the potential LV pacing vectors based on one or both of the signal amplitude and the pacing impedance.

5. The method of claim 3, wherein each potential LV pacing vector is defined between a viable cathode electrode and a selected anode electrode and further comprising:

monitoring one or more of the potential LV pacing vectors for anodal stimulation;

storing anodal stimulation information associated with the one or more potential LV pacing vectors together with the ranking of the potential LV pacing vectors.

6. The method of claim 3, further comprising automatically changing from a first LV pacing vector used to deliver pacing to a second LV pacing vector used to deliver pacing based on the ranking.

7. The method of claim 1, further including measuring one or more of an intrinsic signal amplitude and a pacing impedance, and wherein eliminating one or more cardiac electrodes from a set of viable cardiac electrodes includes eliminating the one or more cardiac electrodes from the set of viable cardiac electrodes according to the parameter of hemodynamic function and the one or more of the intrinsic signal amplitude and the pacing impedance.

8. The method of claim 1, wherein measuring the values of the hemodynamic function parameter comprises measuring a cardiac electrical signal propagation delay.

9. The method of claim 1, further comprising:

identifying a set of hemodynamically preferred cardiac electrodes from the viable cardiac electrodes based on the measured value of the hemodynamic function parameter;

delivering pacing using at least some of the viable cardiac electrodes;

monitoring for phrenic nerve activation caused by the pacing; and

eliminating from further consideration each cardiac electrode of the viable cardiac electrodes that is associated with phrenic nerve activation and which is not included in the set of hemodynamically preferred cardiac electrodes.

10. The method of claim 1, further comprising eliminating from further testing potential LV pacing vectors which are undesirable or not commonly used, wherein the eliminating is based on one or both of survey information and data mining information received as input.