System and method for remote expert-system medical device programming

• US 20080077031A1
• Filed: 11/19/2007
• Published: 03/27/2008
• Est. Priority Date: 11/07/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhu, Qingsheng, Spinelli, Julio
• Granted Patent: US 8,755,897 B2
• Time in Patent Office: Days
• US Class Current: 600/513
• CPC Class Codes: A61N 1/37282 characterised by communication with experts in remote locations using a network
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 40/40 for the management of medical equipment or devices, e.g. scheduling maintenance or upgrades
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

One embodiment includes a system for prescribing therapeutic treatment for a patient via communications over a network, including an implantable medical device (IMD) to be implanted in the patient to record a patient characteristic, the implantable medical device being programmable and configured to communicate via wireless communications with the IMD and to communicate securely over the network, the medical device programming computer including a user interface. The embodiment includes a server to communicate securely over the network with the medical device programming computer, the server including at least a first expert prescription system comprising at least one physician'"'"'s prescription and at least one expert-system to compare the at least one patient characteristic to the at least one physician'"'"'s prescription to issue a parameter to be programmed into the IMD based on the comparison.

Claims

1-14. -14. (canceled)

15. A medical device programmer, comprising:

a data input for receiving PR interval durations measured by a pulse generator;

a data input for receiving a duration interval of a ORS complex and a timing relationship between the right and left ventricular depolarizations;

control circuitry for using at least first and second PR interval durations to select an AV delay interval for delivering one or more ventricular pacing pulses and for using the duration interval of the QRS complex and the timing relationship between right and left ventricular depolarizations to select among ventricular pacing sites in which to provide pacing pulses;

a display screen to display the selected AV delay interval and the selected ventricular pacing site or sites; and

an input to initiate programming the selected AV delay interval and ventricular pacing site or sites into the pulse generator.

17. The medical device programmer of claim 15, wherein the control circuitry includes a receiver/transmitter and a ventricular chamber selector coupled to the data input and the receiver/transmitter, the receiver/transmitter for receiving intrinsic intracardiac electrograms of a left and right ventricle and the ventricular chamber selector for determining the relationship between R_L and R_R, where R_L is a time at which a depolarization in the left ventricle occurred and R_R is a time at which the depolarization in a right ventricle occurred, and suggesting one or more ventricular chambers in which to provide pacing pulses based on the duration interval of the QRS complex and the relationship between R_L and R_R.

18. The medical device programmer of claim 17, wherein the ventricular chamber selector suggests pacing in the left ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_L occurs later than R_R.

19. The medical device programmer of claim 17, wherein the ventricular chamber selector suggests pacing in both the left ventricle and the right ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_L occurs later than R_R.

20. The medical device programmer of claim 17, wherein the ventricular chamber selector suggests pacing in the right ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_R occurs later than R_L or at the same time as R_L.

47. The medical device programmer of claim 15, wherein the control circuitry is configured to select an AV delay interval by computing a weighted average of the first and second PR interval durations.

48. The medical device programmer of claim 47, wherein the control circuitry is configured to compute the weighted average using an intrinsic coefficient when the most recent PR interval is concluded by an intrinsic beat and to compute the weighted average using a paced coefficient when the most recent PR interval is concluded by a paced beat.

49. The medical device programmer of claim 47, further comprising an input to receive a selected weighting coefficient for computing the weighted average.

50. The medical device programmer of claim 48, further comprising an input to receive selected intrinsic and paced coefficients for computing the weighted average.

59. The medical device programmer of claim 15, further comprising control circuitry for using the timing relationship between right and left ventricular depolarizations to select an LV offset value for use in biventricular pacing.

16. (canceled)

21-46. -46. (canceled)

51. A method for operating a medical device programmer, comprising:

receiving PR interval durations measured by a pulse generator;

receiving a duration interval of a QRS complex and a timing relationship between the right and left ventricular depolarizations;

using at least first and second PR interval durations to select an AV delay interval for delivering one or more ventricular pacing pulses;

using the duration interval of a ORS complex and the timing relationship between right and left ventricular depolarizations to select among ventricular pacing sites in which to provide pacing pulses;

displaying the selected AV delay interval and the selected ventricular pacing site or sites; and

programming the selected AV delay interval and ventricular pacing site or sites into the pulse generator.

53. The method of claim 51, further comprising determining the relationship between R_L and R_R, where R_L is a time at which a depolarization in the left ventricle occurred and R_R is a time at which the depolarization in a right ventricle occurred, and selecting one or more ventricular chambers in which to provide pacing pulses based on the duration interval of the QRS complex and the relationship between R_L and R_R.

54. The method of claim 53, further comprising selecting pacing in the left ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_L occurs later than R_R.

55. The method of claim 53, further comprising selecting pacing in both the left ventricle and the right ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_L occurs later than R_R.

56. The method of claim 53, further comprising selecting pacing in the right ventricle when the duration interval of the QRS complex is greater than or equal to 120 milliseconds and R_R occurs later than R_L or at the same time as R_L.

57. The method of claim 51, further comprising selecting an AV delay interval by computing a weighted average of the first and second PR interval durations.

58. The method of claim 57, further comprising computing the weighted average using an intrinsic coefficient when the most recent PR interval is concluded by an intrinsic beat and to compute the weighted average using a paced coefficient when the most recent PR interval is concluded by a paced beat.

60. The method of claim 51, further comprising using the timing relationship between right and left ventricular depolarizations to select an LV offset value for use in biventricular pacing.

52. (canceled)