Systems and methods for configuration of interventricular interval

• US 9,764,143 B2
• Filed: 05/04/2015
• Issued: 09/19/2017
• 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): Holmes, Rex R
• Application Number:
  US14/703,348
• Publication Number:
  US 20160045737A1
• Time in Patent Office: 869 Days
• CPC Class Codes: A61B 5/282 Holders for multiple electrodes for introduction into the body A61B5/287
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/6805 Vests
• CPC Class Codes: A61B 5/7282 Event detection, e.g. detecting unique waveforms indicative of a medical condition A61B5/4094, A61B5/4818, A61B5/349, A61B5/0823 take precedence
• 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 1/36843 Bi-ventricular stimulation
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means

Abstract

Systems and methods are described herein for assisting a user in identification of interventricular (V-V) delay for 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 V-V intervals and may identify a V-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 bi-ventricular pacing therapy at a plurality of different V-V intervals,

monitor electrical activity using the plurality of external electrodes for each of the plurality of V-V intervals during the delivery of bi-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 V-V intervals based on the monitored electrical activity, and

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

2. 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 V-V interval from the plurality of different V-V intervals based on the electrical heterogeneity information comprises identifying the V-V interval from the plurality of different V-V intervals that generated the lowest global standard deviation of surrogate electrical activation times.

3. The system of claim 1, wherein the plurality of electrodes comprises two or more left external electrodes configured to be located proximate the left side of the patient, 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 V-V interval from the plurality of different V-V intervals based on the electrical heterogeneity information comprises identifying the V-V interval from the plurality of different V-V intervals that generated the lowest left standard deviation.

4. The system of claim 1, wherein the plurality of electrodes comprises two or more left external electrodes configured to be located proximate the left side of the patient, 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 V-V interval from the plurality of different V-V intervals based on the electrical heterogeneity information comprises identifying the V-V interval from the plurality of different V-V intervals that generated the lowest left average.

5. The system of claim 1, wherein the computing apparatus configures the plurality of different V-V intervals of the bi-ventricular pacing therapy to pre-excite the left ventricle if the electrical heterogeneity information indicates an increase in heterogeneity in the electrical activity monitored by the plurality of external electrodes.

6. The system of claim 1, wherein the plurality of electrodes comprises two or more left external electrodes configured to be located proximate the left side of the patient, wherein the plurality of electrodes comprises two or more posterior external electrodes configured to be located proximate the posterior side of the patient,

wherein the computing apparatus configures the plurality of different V-V intervals of the bi-ventricular pacing therapy to pre-excite the left ventricle if the monitored electrical activity indicates an increase in surrogate electrical activation times monitored by at least one of the two or more left external electrodes and the two or more posterior external electrodes.

7. The system of claim 1, wherein the plurality of electrodes comprises two or more right external electrodes configured to be located proximate the right side of the patient, wherein the plurality of electrodes comprises two or more anterior external electrodes configured to be located proximate the anterior side of the patient,

wherein the computing apparatus configures the plurality of different V-V intervals of the bi-ventricular pacing therapy to pre-excite the right ventricle if the monitored electrical activity indicates an increase in surrogate electrical activation times monitored by at least one of the two or more right external electrodes and the two or more anterior external electrodes.

8. 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.

9. 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 assisting a user in evaluating and adjusting cardiac therapy delivered to a patient,

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

10. The system of claim 9, wherein the computing apparatus is further configured to display a graphical representation of surrogate electrical activation times monitored by the plurality of external electrodes about a portion of human anatomy monitored for each V-V interval of the plurality of different V-V intervals.

11. The system of claim 10, wherein displaying the graphical representation of the surrogate cardiac electrical activation times about a portion of human anatomy comprises color scaling the portion of human anatomy on the graphical user interface according to the surrogate electrical activation times.

12. The system of claim 1, wherein the pacing therapy is delivered by at least one implantable electrode coupled to at least one lead.

13. The system of claim 1, wherein the bi-ventricular pacing therapy is delivered at an optimized A-V interval.

14. 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;

monitor electrical activity using the plurality of external electrodes,

initiate delivery of bi-ventricular pacing therapy at an initial V-V interval,

generate initial electrical heterogeneity information representative of at least one of mechanical cardiac functionality and electrical cardiac functionality for the initial V-V interval based on the electrical activity monitored during the delivery of bi-ventricular pacing therapy at the initial V-V interval,

configure a plurality of different V-V intervals to pre-excite the left ventricle or the right ventricle based on the initial electrical heterogeneity information,

initiate delivery of bi-ventricular pacing therapy at the plurality of different V-V intervals,

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

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

15. A method for use in cardiac therapy comprising:

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

monitoring electrical activity using a plurality of external electrodes for each of the plurality of V-V intervals during the delivery of bi-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 V-V intervals based on the monitored electrical activity; and

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

16. 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 V-V interval from the plurality of different V-V intervals based on the electrical heterogeneity information comprises identifying the V-V interval from the plurality of different V-V intervals that generated the lowest global standard deviation of surrogate electrical activation times.

17. The method of claim 15, wherein the plurality of electrodes comprises two or more left external electrodes configured to be located proximate the left side of the patient, 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 V-V interval from the plurality of different V-V intervals based on the electrical heterogeneity information comprises identifying the V-V interval from the plurality of different V-V intervals that generated the lowest left standard deviation.

18. The method of claim 15, wherein the plurality of electrodes comprises two or more left external electrodes configured to be located proximate the left side of the patient, 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 V-V interval from the plurality of different V-V intervals based on the electrical heterogeneity information comprises identifying the V-V interval from the plurality of different V-V intervals that generated the lowest left average.

19. The method of claim 15, wherein the method further comprises configuring the plurality of different V-V intervals of the bi-ventricular pacing therapy to pre-excite the left ventricle if the electrical heterogeneity information indicates an increase in heterogeneity in the electrical activity monitored by the plurality of external electrodes.

20. The method of claim 15, wherein the plurality of electrodes comprises two or more left external electrodes configured to be located proximate the left side of the patient, wherein the plurality of electrodes comprises two or more posterior external electrodes configured to be located proximate the posterior side of the patient,

wherein the method further comprises configuring the plurality of different V-V intervals of the bi-ventricular pacing therapy to pre-excite the left ventricle if the monitored electrical activity indicates an increase in surrogate electrical activation times monitored by at least one of the two or more left external electrodes and the two or more posterior external electrodes.

21. The method of claim 15, wherein the plurality of electrodes comprises two or more right external electrodes configured to be located proximate the right side of the patient, wherein the plurality of electrodes comprises two or more anterior external electrodes configured to be located proximate the anterior side of the patient,

wherein the method further comprises configuring the plurality of different V-V intervals of the bi-ventricular pacing therapy to pre-excite the right ventricle if the monitored electrical activity indicates an increase in surrogate electrical activation times monitored by at least one of the two or more right external electrodes and the two or more anterior external electrodes.

22. 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.

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

24. The method of claim 23, wherein the method further comprises displaying, on the graphical user interface, a graphical representation of surrogate electrical activation times monitored by the plurality of external electrodes about a portion of human anatomy monitored for each V-V interval of the plurality of different V-V intervals.

25. A method for use in cardiac therapy comprising:

monitoring electrical activity using a plurality of external electrodes;

initiating delivery of bi-ventricular pacing therapy at an initial V-V interval;

generating initial electrical heterogeneity information representative of at least one of mechanical cardiac functionality and electrical cardiac functionality for the initial V-V interval based on the electrical activity monitored during the delivery of bi-ventricular pacing therapy at the initial V-V interval;

configuring a plurality of different V-V intervals to pre-excite the left ventricle or the right ventricle based on the initial electrical heterogeneity information;

initiating delivery of bi-ventricular pacing therapy at the plurality of different V-V intervals;

generating electrical heterogeneity information representative of at least one of mechanical cardiac functionality and electrical cardiac functionality for each of the plurality of V-V intervals based on the electrical activity monitored during the delivery of bi-ventricular pacing therapy at the plurality of different V-V intervals; and

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