LEFT-VENTRICULAR PACING SITE SELECTION GUIDED BY ELECTROGRAM MORPHOLOGY ANALYSIS

• US 20130053916A1
• Filed: 08/30/2012
• Published: 02/28/2013
• Est. Priority Date: 08/30/2011
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Sambelashvili, Aleksandre T., Stadler, Robert W.
• Granted Patent: US 9,180,300 B2
• Time in Patent Office: Days
• US Class Current: 607/27
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• 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 1/3684 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
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A medical device and associated method classify candidate pacing electrode sites for delivering pacing pulses to a patient'"'"'s heart. A first morphology template is established and stored in memory of the device. A processor is configured to determine a cardiac signal morphology in response to delivering pacing pulses at a candidate pacing site in a first heart chamber. The processor compares the determined cardiac signal morphology to the first morphology template. The pacing site in the first heart chamber is classified in response to the comparing of the determined cardiac signal morphology and the first morphology template.

Claims

1. A method for determining a pacing electrode site for delivering pacing pulses to a patient'"'"'s heart, the method comprising:

sensing a cardiac signal;

controlling delivery of a pacing pulse at a first pacing site in a first heart chamber;

determining a cardiac signal morphology in response to the cardiac signal sensed during pacing pulse delivery in the first heart chamber and comparing the determined cardiac morphology to a first morphology template; and

classifying the first pacing site in the first heart chamber in response to the comparing of the determined cardiac morphology and the first morphology template.

2. The method of claim 1, further comprising determining the first morphology template, wherein determining the first morphology template comprises receiving the cardiac signal and determining the first morphology template in response to no pacing pulses being delivered in the first heart chamber.

3. The method of claim 2, wherein the first morphology template is generated during an intrinsic cardiac rhythm, and further comprising:

determining a second morphology template during pacing in a second heart chamber and comparing the determined cardiac morphology to the second morphology template; and

classifying the pacing electrode site in the first heart chamber in response to the comparing of the determined cardiac morphology to the first morphology template and the second morphology template.

4. The method of claim 1, further comprising determining a morphology matching score in response to the comparing and determining a pacing site score in response to the morphology matching score.

5. The method of claim 1, further comprising:

determining a bundle branch block morphology template;

comparing the determined cardiac morphology to the bundle branch morphology template; and

classifying the pacing electrode site in the first heart chamber in response to the comparing the determined cardiac morphology to the bundle branch morphology template.

6. The method of claim 5, wherein the bundle branch block morphology corresponds to a right bundle branch block morphology and further comprising:

determining a bundle branch block correlation threshold and a control correlation threshold; and

classifying the pacing electrode site in the first heart chamber as being a non-recommended site in response to the determined cardiac morphology being outside the established bundle branch block correlation threshold of the right bundle branch block morphology and being within the control correlation threshold of the first morphology template.

7. The method of claim 1, further comprising:

delivering pacing pulses at a plurality of pacing sites along the first heart chamber;

determining a cardiac morphology for each of the plurality of pacing sites and determining a difference between each of the determined cardiac morphologies and the first morphology template; and

classifying each of the plurality of pacing sites, wherein the classifying comprises one of classifying one of the plurality of pacing sites corresponding to a greatest relative difference between a respective determined cardiac morphology and the first morphology template as a recommended site, and classifying one of the plurality of pacing sites corresponding to a least relative difference between a respective determined cardiac morphology and the first morphology template as a non-recommended site.

8. The method of claim 1, further comprising:

controlling delivery of pacing pulses at the first pacing site at a plurality of pacing time intervals;

determining a cardiac morphology for each of the plurality of pacing timing intervals, comparing each of the determined cardiac morphologies to the first morphology template, and determining a longest pacing time interval at which the respective determined cardiac morphology does not approximately match the first morphology template;

controlling delivery of pacing pulses at a plurality of pacing time intervals at a second pacing site along the first heart chamber; and

determining a second cardiac morphology for each of the plurality of pacing timing intervals during pacing at the second pacing site, comparing each of the second cardiac morphologies to the first morphology template, and determining a longest pacing time interval at which the respective second cardiac morphology does not approximately match the first morphology template, wherein classifying the pacing electrode site in the first heart chamber comprises identifying one of the first pacing site and the second pacing site corresponding to the longest one of the determined pacing time intervals.

9. The method of claim 1, further comprising:

determining a pacing site score in response to the comparing; and

displaying the pacing site score to a user.

10. The method of claim 1, further comprising:

determining a morphology difference threshold;

delivering pacing pulses at a plurality of pacing sites along the first heart chamber;

determining a cardiac morphology for each of the plurality of pacing sites and determining a difference between each of the respective cardiac morphologies and the first morphology template;

determining ones of the plurality of pacing sites associated with a difference between the respective cardiac morphologies and the first morphology template less than the established morphology difference threshold; and

classifying the identified ones of the plurality of pacing sites as sites not recommended for selection as the pacing electrode site in the first heart chamber.

11. A medical device for determining a pacing electrode site and delivering pacing pulses to a patient'"'"'s heart, the device comprising:

a plurality of electrodes for delivering pacing pulses to a patient'"'"'s heart;

a control unit operatively coupled with the plurality of electrodes for controlling the delivery of the pacing pulses, including selecting electrodes for delivering the pacing pulses;

a sensing module for sensing a cardiac signal;

a memory storing a first morphology template; and

a processor configured to receive the cardiac signal, determine a cardiac signal morphology in response to the cardiac signal sensed during pacing pulse delivery in a first heart chamber, compare the determined cardiac signal morphology to a first morphology template, and classify a pacing electrode site in the first heart chamber in response to the comparing of the determined cardiac signal morphology to the first morphology template.

12. The device of claim 11, wherein the processor is further configured to determine the first morphology template in response to the sensed cardiac signal when no pacing pulses are being delivered in the first heart chamber.

13. The device of claim 12, wherein the first morphology template is determined during an intrinsic cardiac rhythm, the processor further configured to determine a second morphology template during pacing in a second heart chamber, compare the determined cardiac signal morphology to the second morphology template and classify the pacing electrode site in the first heart chamber in response to the comparing of the determined cardiac signal morphology to the first morphology template and the second morphology template.

14. The device of claim 11, wherein the processor is further configured to determine a morphology matching score in response to the comparing and to determine a pacing site score using the morphology matching score.

15. The device of claim 11, further comprising a memory storing an established bundle branch block morphology template, the processor configured figured to compare the determined cardiac signal morphology to the bundle branch morphology template, and classify the pacing electrode site in the first heart chamber in response to the comparing of the determined cardiac signal morphology to the bundle branch block morphology template.

16. The device of claim 15, wherein the bundle branch block morphology corresponds to a right bundle branch block morphology, the memory stores a bundle branch block correlation threshold and a control morphology correlation threshold, and wherein the pacing electrode site in the first heart chamber is classified as a non-recommended site in response to the determined cardiac signal morphology being outside the bundle branch block correlation threshold of the right bundle branch block morphology and being within the control morphology correlation threshold of the first morphology template.

17. The device of claim 11, wherein the control unit controls delivery of pacing pulses at a plurality of pacing sites along the first heart chamber, and wherein the processor is further configured to generate a determined cardiac signal morphology for each of the plurality of pacing sites, determine a difference between each of the respective determined cardiac signal morphologies and the first morphology template and classify each of the plurality of pacing sites, the classifying comprising one classifying one of the plurality of pacing sites corresponding to a greatest relative difference between a respective determined cardiac signal morphology and the first morphology template as a recommended site, and classifying one of the plurality of pacing sites corresponding to a least relative difference between a respective determined cardiac signal morphology and the first morphology template as a non-recommended site.

18. The device of claim 11, wherein the control unit controls delivery of pacing pulses at the first pacing site at a plurality of pacing time intervals;

the processor is further configured to determine a cardiac signal morphology for each of the plurality of pacing timing intervals, compare each of the respective determined cardiac signal morphologies to the first morphology template, and determine a longest pacing time interval at which the respective determined cardiac signal morphology does not approximately match the first morphology template;

the control unit controlling delivery of pacing pulses at a plurality of pacing time intervals at a second pacing site along the first heart chamber;

the processor is further configured to generate a second determined cardiac signal morphology for each of the plurality of pacing timing intervals during pacing at the second pacing site, compare each of the respective second determined cardiac signal morphologies to the first morphology template, and determine a longest pacing time interval at which the respective determined cardiac signal morphology does not approximately match the first morphology template, and wherein classifying the pacing electrode site in the first heart chamber comprises identifying one of the first pacing site and the second pacing site corresponding to a longest one of the determined pacing time intervals.

19. The device of claim 11, wherein the processor is further configured to compute a pacing site score in response to the comparing, and further comprising a display for displaying the pacing site score to a user.

20. The device of claim 11, further comprising:

a memory storing an established morphology difference threshold; and

a display device, wherein the control unit is configured to control pacing pulse delivery at a plurality of pacing sites along the first heart chamber by selecting from a plurality of electrodes, and the processor further configured to determine a second cardiac signal morphology for each of the plurality of pacing sites and to determine a difference between each of the respective second determined cardiac signal morphologies and the first morphology template, identify ones of the plurality of pacing sites associated with a difference between the respective ones of the second determined cardiac signal morphologies and the first morphology template that is less than the established morphology difference threshold, and wherein the identified ones of the plurality of pacing sites are displayed on the display device as sites being not recommended for selection as the pacing electrode site in the first heart chamber.

21. A non-transitory computer-readable medium storing instructions which cause a medical device to perform a method, the method comprising:

sensing a cardiac signal;

controlling delivery of a pacing pulse at a first pacing site in a first heart chamber;

determining a cardiac signal morphology in response to the cardiac signal sensed during pacing pulse delivery in the first heart chamber and comparing the determined cardiac morphology to a first morphology template; and

classifying the first pacing site in the first heart chamber in response to the comparing of the determined cardiac morphology and the first morphology template.