Method and apparatus for automatically programming CRT devices

• US 20050043895A1
• Filed: 02/14/2004
• Published: 02/24/2005
• Est. Priority Date: 08/20/2003
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Schechter, Stuart O.
• Granted Patent: US 7,065,400 B2
• Time in Patent Office: Days
• US Class Current: 702/19
• CPC Class Codes: A61B 5/02028 Determining haemodynamic parameters not otherwise provided for, e.g. cardiac contractility or left ventricular ejection fraction
• CPC Class Codes: A61B 5/053 Measuring electrical impedance or conductance of a portion of the body
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61B 8/08 Detecting organic movements or changes, e.g. tumours, cysts, swellings A61B8/02 - A61B8/06 take precedence
• CPC Class Codes: A61B 8/0883 for diagnosis of the heart
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

External or internal monitoring equipment is used to automatically determine optimal programming parameters for a CRT based on externally or internally derived measurements of cardiac performance, anisotropic myocardial deformation (AMD) or both. The ideal programming parameter, operational parameter, represents optimal interval timing between multiple electrodes within the CRT, and is generated by such a closed loop control system. The closed loop system may be semi-automatic and implement connectivity to external ultrasound equipment or externally derived measurements of transthoracic impedance. Preferably, the operational parameter is determined by a closed loop system using internally derived intracardiac and intrathoracic electrograms and impedance measurements that describe cardiac performance and electromechanical dysynchrony in real time. Such a CRT has a control system that automatically optimizes performance by a system of checks and balance.

Claims

1. An apparatus for programming a CRT automatically comprising:

a programmer that provides operational parameters to a CRT;

a monitor that monitors physiological characteristics of the heart of a patient and determines a programming parameter for a patient'"'"'s heart based on said characteristics; and

a calculator receiving said programming parameter and generating said operational parameter for said programmer.

2. The apparatus of claim 1 wherein said programmer applies a plurality of stimulations to the patient'"'"'s heart and said calculator monitors the resulting programming parameter and selects the optimal programming parameter and the corresponding operational parameter.

3. The apparatus of claim 1 wherein said equipment is ultrasonic equipment.

4. The apparatus of claim 1 wherein said equipment is an impedance measuring device or monitor.

5. The apparatus of claim 4 wherein said monitor is external.

6. The apparatus of claim 4 wherein said monitor is implemented in the CRT.

7. The apparatus of claim 1 wherein said programming parameter is indicative of cardiac performance.

8. The apparatus of claim 1 wherein said programming parameter is indicative of AMD.

9. The apparatus of claim 1 wherein said programming parameter is determined from a plurality of functions, each function being associated with a myocardial region during a cardiac cycle.

10. The apparatus of claim 9 wherein said functions define myocardial strain measurements derived from specific regions of interest.

11. The apparatus of claim 9 wherein the said functions are defined by myocardial velocity measurements derived from specific regions of interest.

12. The apparatus of claim 9 wherein the programming parameter is associated with transthoracic impedance.

13. An apparatus for programming a CRT comprising:

equipment that monitors several programming parameters;

a calculator that selects an optimal parameter from said programming parameter and generates an operational parameter for said CRT based on said optimal parameter.

14. The apparatus of claim 13 wherein said programming parameters are based on Doppler ultrasound quantification of velocity of multiple pre-selected myocardial regions during a cardiac cycle.

15. The apparatus of claim 14 wherein said programming parameters depend on one of strain or velocity.

16. The apparatus of claim 13 wherein said calculator generates said optimal parameter based on one of cardiac performance and/or AMD.

17. An implantable CRT comprising:

equipment that monitors a programming parameter; and

a calculator that selects an optimal value for said programming parameter and uses said optimal value to generate an operational parameter, said operational parameter defining the normal mode of operation of said CRT.

18. The implantable CRT of claim 17 wherein said equipment monitors an AMD parameter and a cardiac performance parameter and said calculator selects the optimal value on both said AMD and cardiac performance parameters.

19. The implantable CRT of claim 17 wherein said calculator monitors the performance of the heart and under certain pre-determined sub-critical or critical conditions switches from an operational parameter based on AMD to an operational parameter based on cardiac performance.