Systems and methods for configuration of atrioventricular interval

• US 9,586,050 B2
• Filed: 05/04/2015
• Issued: 03/07/2017
• Est. Priority Date: 08/15/2014
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghosh, Subham, Gillberg, Jeffrey
• Primary Examiner(s): Wieland, Robert N
• Application Number:
  US14/703,365
• Publication Number:
  US 20160045738A1
• Time in Patent Office: 673 Days
• US Class Current: 1/1
• CPC Class Codes: A61B 5/282 Holders for multiple electrodes for introduction into the body A61B5/287
• CPC Class Codes: A61B 5/6823 Trunk, e.g., chest, back, abdomen, hip
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• 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 1/3682 with a variable atrioventricular delay
• 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 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: A61N 1/37264 Changing the program; Upgrading firmware

Abstract

Systems and methods are described herein for assisting a user in identification and/or optimization of an atrioventricular (A-V) interval for use in cardiac therapy. The systems and methods may monitor electrical activity of a patient using external electrode apparatus to provide electrical heterogeneity information for a plurality of different A-V intervals and may identify an A-V interval based on the electrical heterogeneity information.

Claims

1. A system for use in cardiac therapy comprising:

electrode apparatus comprising a plurality of external electrodes configured to be located proximate tissue of a patient; and

computing apparatus coupled to the electrode apparatus and configured to;

initiate delivery of left ventricular pacing therapy at a plurality of different A-V intervals, wherein the left ventricular pacing therapy is delivered using at least one pacing electrode configured to pace the patient'"'"'s left ventricle and without any sensing electrodes located in the patient'"'"'s right ventricle,

monitor electrical activity using the plurality of external electrodes during the delivery of left ventricular pacing therapy,

generate electrical heterogeneity information representative of at least one of mechanical cardiac functionality and electrical cardiac functionality for each of the plurality of different A-V intervals based on the monitored electrical activity, and

identify an A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information.

2. The system of claim 1, wherein the plurality of different A-V intervals comprises a plurality of paced A-V intervals (PAV) and a plurality of sensed A-V intervals (SAV).

3. The system of claim 1, wherein the electrical heterogeneity information comprises at least one metric of global or local surrogate electrical heterogeneity.

4. The system of claim 1, wherein the electrical heterogeneity information comprises a global standard deviation of surrogate electrical activation times monitored by the plurality of external electrodes, wherein identifying a A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information comprises identifying the A-V interval from the plurality of different A-V intervals that generated the lowest global standard deviation of surrogate electrical activation times.

5. The system of claim 1, wherein the electrical heterogeneity information comprises a left standard deviation of surrogate electrical activation times monitored by the two or more left external electrodes, wherein identifying a A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information comprises identifying the A-V interval from the plurality of different A-V intervals that generated the lowest left standard deviation of surrogate electrical activation times.

6. The system of claim 1, wherein the electrical heterogeneity information comprises a left average of surrogate electrical activation times monitored by the two or more left external electrodes, wherein identifying a A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information comprises identifying the A-V interval from the plurality of different A-V intervals that generated the lowest left average of surrogate electrical activation times.

7. The system of claim 1, wherein identifying an A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information further comprises identifying an A-V interval from the plurality of different A-V intervals based on a QRS duration metric for each A-V interval of the plurality of different A-V intervals.

8. The system of claim 1, wherein initiating delivery of left ventricular pacing therapy at a plurality of different A-V intervals comprises:

setting the A-V interval to an initial A-V interval value;

delivering left ventricular pacing therapy at the A-V interval; and

periodically increasing the A-V interval by a selected increment until an intrinsic A-V conduction is sensed.

9. The system of claim 1, wherein the plurality of external electrodes comprises surface electrodes positioned in an array configured to be located proximate the skin of the torso of the patient.

10. The system of claim 1, wherein the system further comprises display apparatus, wherein the display apparatus comprises a graphical user interface configured to present information for use in evaluating and adjusting left ventricular cardiac therapy delivered to a patient,

wherein the computing apparatus is further configured to display at least the identified A-V interval on the graphical user interface.

11. A system for use in cardiac therapy comprising:

electrode apparatus comprising a plurality of external electrodes configured to be located proximate tissue of a patient; and

computing apparatus coupled to the electrode apparatus and configured to;

initiate delivery of left ventricular pacing therapy at a plurality of different A-V intervals,

monitor electrical activity using the plurality of external electrodes during the delivery of left ventricular pacing therapy,

generate electrical heterogeneity information representative of at least one of mechanical cardiac functionality and electrical cardiac functionality for each of the plurality of different A-V intervals based on the monitored electrical activity,

identify an A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information, and

determine a difference value for use in adjusting the A-V interval during left ventricular pacing therapy based on the identified A-V interval and an intrinsic A-V conduction time.

12. The system of claim 11, wherein the pacing therapy is delivered using at least one pacing electrode configured to pace the patient'"'"'s left ventricle and without any sensing electrodes located in the patient'"'"'s right ventricle.

13. The system of claim 11, wherein the difference value is configured to be used periodically during the delivery of left ventricular pacing therapy such that, periodically, a patient'"'"'s intrinsic A-V conduction time is measured and the difference value is applied to the measured intrinsic A-V conduction time to provide the A-V interval used in the delivery of pacing therapy.

14. The system of claim 13, wherein, if the provided A-V interval is greater than or equal to a threshold value, the provided A-V interval is not used in the delivery of pacing therapy.

15. A method for use in cardiac therapy comprising:

initiating delivery of left ventricular pacing therapy at a plurality of different A-V intervals, wherein the left ventricular pacing therapy is delivered using at least one pacing electrode configured to pace the patient'"'"'s left ventricle and without any sensing electrodes located in the patient'"'"'s right ventricle;

monitoring electrical activity using a plurality of external electrodes during the delivery of left ventricular pacing therapy;

generating electrical heterogeneity information representative of at least one of mechanical cardiac functionality and electrical cardiac functionality for each of the plurality of different A-V intervals based on the monitored electrical activity; and

identifying an A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information.

16. The method of claim 15, wherein the plurality of different A-V intervals comprises a plurality of paced A-V intervals (PAV) and a plurality of sensed A-V intervals (SAV).

17. The method of claim 15, wherein the electrical heterogeneity information comprises at least one metric of global or local surrogate electrical heterogeneity.

18. The method of claim 15, wherein the electrical heterogeneity information comprises a global standard deviation of surrogate electrical activation times monitored by the plurality of external electrodes, wherein identifying a A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information comprises identifying the A-V interval from the plurality of different A-V intervals that generated the lowest global standard deviation of surrogate electrical activation times.

19. The method of claim 15, wherein the electrical heterogeneity information comprises a left standard deviation of surrogate electrical activation times monitored by the two or more left external electrodes, wherein identifying a A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information comprises identifying the A-V interval from the plurality of different A-V intervals that generated the lowest left standard deviation of surrogate electrical activation times.

20. The method of claim 15, wherein the electrical heterogeneity information comprises a left average of surrogate electrical activation times monitored by the two or more left external electrodes, wherein identifying a A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information comprises identifying the A-V interval from the plurality of different A-V intervals that generated the lowest left average of surrogate electrical activation times.

21. The method of claim 15, wherein identifying an A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information further comprises identifying an A-V interval from the plurality of different A-V intervals based on a QRS duration metric for each A-V interval of the plurality of different A-V intervals.

22. The method of claim 15, wherein initiating delivery of left ventricular pacing therapy at a plurality of different A-V intervals comprises:

setting the A-V interval to an initial A-V interval value;

delivering left ventricular pacing therapy at the A-V interval; and

periodically increasing the A-V interval by a selected increment until an intrinsic A-V conduction is sensed.

23. The method of claim 15, wherein the plurality of external electrodes comprises surface electrodes positioned in an array configured to be located proximate the skin of the torso of the patient.

24. The method of claim 15, wherein the method further comprises displaying display at least the identified A-V interval on a graphical user interface configured to present information for use in evaluating and adjusting left ventricular cardiac therapy delivered to a patient.

25. A method for use in cardiac therapy comprising:

initiating delivery of left ventricular pacing therapy at a plurality of different A-V intervals;

monitoring electrical activity using a plurality of external electrodes during the delivery of left ventricular pacing therapy;

generating electrical heterogeneity information representative of at least one of mechanical cardiac functionality and electrical cardiac functionality for each of the plurality of different A-V intervals based on the monitored electrical activity;

identifying an A-V interval from the plurality of different A-V intervals based on the electrical heterogeneity information; and

determining a difference value for use in adjusting the A-V interval during left ventricular pacing therapy based on the identified A-V interval and an intrinsic A-V conduction time.

26. The method of claim 25, wherein the pacing therapy is delivered using at least one pacing electrode configured to pace the patient'"'"'s left ventricle and without any sensing electrodes located in the patient'"'"'s right ventricle.

27. The method of claim 25, wherein the difference value is configured to be used periodically during the delivery of left ventricular pacing therapy such that, periodically, a patient'"'"'s intrinsic A-V conduction time is measured and the difference value is applied to the measured intrinsic A-V conduction time to provide the A-V interval used in the delivery of pacing therapy.

28. The method of claim 27, wherein, if the provided A-V interval is greater than or equal to a threshold value, the provided A-V interval is not used in the delivery of pacing therapy.