Assessing intra-cardiac activation patterns

• US 9,974,457 B2
• Filed: 03/02/2015
• Issued: 05/22/2018
• Est. Priority Date: 05/03/2011
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghosh, Subham, Gillberg, Jeffrey M., Stadler, Robert W.
• Primary Examiner(s): Thangavelu, Kandasamy
• Application Number:
  US14/635,498
• Publication Number:
  US 20150216434A1
• Time in Patent Office: 1,177 Days
• CPC Class Codes: A61B 5/02 Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
• CPC Class Codes: A61B 5/05 Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves impedance plethysmography A61B5/0295; measuring movement of the entire body or parts thereof A61B5/11; detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof A61B5/24
• CPC Class Codes: A61B 5/282 Holders for multiple electrodes for introduction into the body A61B5/287
• CPC Class Codes: A61B 5/316 Modalities, i.e. specific diagnostic methods
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/339 Displays specially adapted therefor
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/742 using visual displays A61B5/339 takes precedence
• CPC Class Codes: A61N 1/0476 Array electrodes (including any electrode arrangement with more than one electrode for at least one of the polarities)
• CPC Class Codes: A61N 1/0484 Garment electrodes worn by the patient
• 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 1/3682 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 1/36843 Bi-ventricular stimulation

Abstract

Techniques for evaluating cardiac electrical dyssynchrony are described. In some examples, an activation time is determined for each of a plurality of torso-surface potential signals. The dispersion or sequence of these activation times may be analyzed or presented to provide variety of indications of the electrical dyssynchrony of the heart of the patient. In some examples, the locations of the electrodes of the set of electrodes, and thus the locations at which the torso-surface potential signals were sensed, may be projected on the surface of a model torso that includes a model heart. The inverse problem of electrocardiography may be solved to determine electrical activation times for regions of the model heart based on the torso-surface potential signals sensed from the patient.

Claims

1. A system comprising

a plurality of electrodes;

and

a processing unit configured to;

receive a torso-surface potential signal sensed by each electrode of the plurality of electrodes while the electrodes are distributed on a torso of a patient,

project each of the torso-surface potential signals onto a respective location on a surface of a model torso based on locations of the electrodes on the torso of the patient,

determine a set of cardiac activation times for a model heart within the model torso based on the projected torso-surface potential signals and a location of the model heart within the model torso, and

determine a parameter of cardiac resynchronization therapy (CRT) for the patient based on the set of cardiac activation times.

2. The system of claim 1, wherein the processing unit is configured to determine the parameter of CRT by at least selecting one or more electrodes with which a medical device delivers the CRT to the patient.

3. The system of claim 1, wherein the processing unit is configured to determine the parameter of CRT by at least selecting a position of a medical lead within a heart of the patient based on the set of cardiac activation times.

4. The system of claim 1, wherein the parameter of CRT comprises a pacing vector for the CRT.

5. The system of claim 1, wherein the parameter of CRT comprises a timing parameter with which a medical device delivers the CRT to the patient.

6. The system of claim 5, wherein the timing parameter comprises at least one of an atrio-ventricular (A-V) delay or an intra-ventricular (V-V) delay for the CRT.

7. The system of claim 1, wherein the parameter of CRT comprises a pacing threshold with which a medical device delivers the CRT to the patient.

8. The system of claim 1, wherein the processing unit is configured to determine the parameter of CRT by at least selecting one or more tissue sites within the patient for the delivery of the CRT by a medical device.

9. The system of claim 1, wherein the processing unit is further configured to:

receive an updated torso-surface potential signal sensed by each of the plurality of electrodes distributed on the torso of the patient during delivery of the CRT to the patient by a medical device;

project each of the updated torso-surface potential signals onto a respective location on the surface of the model torso based on locations of the electrodes on the torso of the patient; and

determine an updated set of cardiac activation times for the model heart within the model torso based on the projected updated torso-surface potential signals and the location of the model heart within the model torso.

10. The system of claim 9, wherein the updated torso-surface potential signals comprise at least one torso-surface potential signal sensed by an electrode during delivery of the CRT to the patient by the medical device via an endocardial lead.

11. A method comprising:

receiving, by a processing unit, a torso-surface potential signal sensed by each electrode of a plurality of electrodes while the electrodes are distributed on a torso of a patient;

projecting, by the processing unit, each of the torso-surface potential signals onto a respective location on a surface of a model torso based on locations of the electrodes on the torso of the patient;

determining, by the processing unit, a set of cardiac activation times for a model heart within the model torso based on the projected torso-surface potential signals and a location of the model heart within the model torso; and

determining, by the processing unit, a parameter of cardiac resynchronization therapy (CRT) for the patient based on the set of cardiac activation times.

12. The method of claim 11, wherein determining, by the processing unit, the parameter of CRT comprises selecting one or more electrodes with which a medical device delivers the CRT to the patient.

13. The method of claim 11, wherein determining, by the processing unit, the parameter of CRT comprises selecting a position of a medical lead within a heart of the patient based on the set of cardiac activation times.

14. The method of claim 11, wherein the parameter of CRT comprises a pacing vector for the CRT.

15. The method of claim 11, wherein the parameter of CRT comprises a timing parameter with which a medical device delivers the CRT to the patient.

16. The method of claim 15, wherein the timing comprises at least one of an atrio-ventricular (A-V) delay or an intra-ventricular (V-V) delay for the CRT.

17. The method of claim 11, wherein the parameter of CRT comprises a pacing threshold with which a medical device delivers the CRT to the patient.

18. The method of claim 11, wherein determining, by the processing unit, the parameter of CRT comprises selecting one or more tissue sites within the patient for the delivery of the CRT by a medical device.

19. The method of claim 11, further comprising:

receiving, by the processing unit, an updated torso-surface potential signal sensed by each of the plurality of electrodes distributed on the torso of the patient during delivery of the CRT to the patient by a medical device;

projecting, by the processing unit, each of the updated torso-surface potential signals onto a respective location on the surface of the model torso based on locations of the electrodes on the torso of the patient; and

determining, by the processing unit, an updated set of cardiac activation times for the model heart within the model torso based on the projected updated torso-surface potential signals and the location of the model heart within the model torso.

20. The method of claim 19, wherein the updated torso-surface potential signals comprise at least one torso-surface potential signal sensed by an electrode during delivery of the CRT to the patient by the medical device via an endocardial lead.

21. A system comprising:

means for receiving a torso-surface potential signal sensed by each electrode of a plurality of electrodes while the electrodes are distributed on a torso of a patient;

means for projecting each of the torso-surface potential signals onto a respective location on a surface of a model torso based on locations of the electrodes on the torso of the patient;

means for determining a set of cardiac activation times for a model heart within the model torso based on the projected torso-surface potential signals and a location of the model heart within the model torso; and

means for determining a parameter of cardiac resynchronization therapy (CRT) for the patient based on the set of cardiac activation times.

22. The system of claim 21, wherein the parameter of CRT comprises one or more of:

one or more electrodes with which a medical device delivers the CRT pacing to the patient, a position of a medical lead within a heart of the patient, a pacing vector for the CRT, a timing parameter with which the medical device delivers the CRT to the patient, a pacing threshold with which the medical device delivers the CRT to the patient, or comprises one or more tissue sites within the patient for the delivery of the CRT by the medical device.

23. A non-transitory computer-readable storage medium comprising instructions that, when executed by a processing unit, cause the processing unit to:

receive a torso-surface potential signal sensed by each electrode of the plurality of electrodes while the electrodes are distributed on a torso of a patient,

project each of the torso-surface potential signals onto a respective location on a surface of a model torso based on locations of the electrodes on the torso of the patient,

determine a set of cardiac activation times for a model heart within the model torso based on the projected torso-surface potential signals and a location of the model heart within the model torso, and

determine a parameter of cardiac resynchronization therapy (CRT) delivered to the patient based on the set of cardiac activation times.

24. The non-transitory computer-readable storage medium of claim 23, wherein the parameter of CRT comprises one or more of:

one or more electrodes with which a medical device delivers the CRT pacing to the patient, a position of a medical lead within a heart of the patient, a pacing vector for the CRT, a timing parameter with which the medical device delivers the CRT to the patient, a pacing threshold with which the medical device delivers the CRT to the patient, or comprises one or more tissue sites within the patient for the delivery of the CRT by the medical device.