Pacing systems and methods for control of the ventricular activation sequence
First Claim
1. A method for improving the ventricular function of the heart of a patient comprising the steps of:
- (a) monitoring the electrocardiogram of a patient to determine the duration of the patient'"'"'s ZRS complex;
(b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal;
(c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle;
(d) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through each terminal from at least one output pole and electrically connecting at least one electrical group location, or polarity opposite to that of said electrodes, to the other pole of said pulse generator to complete each selected electrical circuit;
(e) providing pacing pulses from said pulse generator to at least two selected terminals, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion;
(f) noninvasevely positioning the location of the pacing pulse by employing said pulse generator noninvasive means to select the one of said terminals that produces the minimum QRS duration with respect to said electrode locations on said lead;
(g) setting said implantable pulse generator at a desired predetermined time interval;
sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and
employing the first of said cardiac signal sin the electronic control circuit of said pulse generator to inhibit the deliverance of pacing pulses to said selected terminal upon occurrence of said first cardiac signal within said predetermined time interval and cause the deliverance of pacing pulses to said selected terminal upon the absence of any said cardiac signal with said predetermined time interval.
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Accused Products
Abstract
Apparatus and methods for improving the ventricular activation sequence of the heart by pacing at an advantageous selected ventricular location to achieve shortening of the QRS complex or pacing at multiple advantageous selected ventricular locations, either simulataneously or with a programmed delay or delays between firings, to achieve shortening of the QRS complex in combination with producing a desirable and efficient ventricular motion. During a cardiac cycle initiated by intrinsic cardiac activity, stimulating impulses may be directed to advantageous selected locations of the ventricles by employing intrinsic cardiac signals to trigger the stimulating impulses, either simultaneously or with a programmed delay or delays between the sensed event or events and firing event or events, to provide improved mechanical and electrical ventricular function.
376 Citations
57 Claims
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1. A method for improving the ventricular function of the heart of a patient comprising the steps of:
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(a) monitoring the electrocardiogram of a patient to determine the duration of the patient'"'"'s ZRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through each terminal from at least one output pole and electrically connecting at least one electrical group location, or polarity opposite to that of said electrodes, to the other pole of said pulse generator to complete each selected electrical circuit; (e) providing pacing pulses from said pulse generator to at least two selected terminals, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) noninvasevely positioning the location of the pacing pulse by employing said pulse generator noninvasive means to select the one of said terminals that produces the minimum QRS duration with respect to said electrode locations on said lead; (g) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and employing the first of said cardiac signal sin the electronic control circuit of said pulse generator to inhibit the deliverance of pacing pulses to said selected terminal upon occurrence of said first cardiac signal within said predetermined time interval and cause the deliverance of pacing pulses to said selected terminal upon the absence of any said cardiac signal with said predetermined time interval.
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2. A method for improving the ventricular function of the heart of a patient comprising the steps of:
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(a) monitoring the electrocardiogram of a patient to determine the duration of the patient'"'"'s QRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with the ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting each terminal to at least one output pole of a pulse generator and electrically connecting at least one electrical group location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete each electrical circuit; (e) providing pacing pulses from said pulse generator to at least one selected terminal, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) analyzing said selected electrode positions to determine their respective resultant QRS durations and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS duration is obtained; (g) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through each terminal from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said implantable pulse generator to complete each selected electrical pacing circuit; (h) providing pacing pulses from said implantable pulse generator to at least two selected terminals, one at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (i) noninvasively positioning the location of the pacing pulse by employing said implantable pulse generator noninvasive means to select the one of said terminals that produces the minimum QRS duration with respect to said electrode locations on said lead; (j) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (l) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to inhibit the deliverance of pacing pulses to said selected terminal upon occurrence of said first cardiac signal within said predetermined time interval and cause the deliverance of pacing pulses to said selected terminal upon the absence of any said cardiac signal within said predetermined time interval. - View Dependent Claims (3, 4, 5)
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6. A method for improving the ventricular function of the heat of a patient comprising the steps of:
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(a) monitoring the electrocardiogram of a patient to determine the duration of the patient'"'"'s QRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle;
(d) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through any combination of said terminals or an individual terminal, from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator to complete the electrical circuits selected and to provide simultaneous pacing pulses to said selected combinations of terminals;(e) providing pacing pulses from said pulse generator to a selected individual terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) noninvasively positioning the location of the pacing pulses by employing said pulse generator to select the combination of said terminals or individual terminal that produces the minimum QRS duration with respect to said electrode locations on said lead; (g) setting said implantable pulse generator at a desired predetermined time interval; (h) sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (i) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to said selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval.
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7. A method for improving the ventricular function of the heart of a patient comprising the steps of:
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(a) monitoring the electrocardiogram of a patient to determine the duration of the patient'"'"'s QRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting selected combinations of said terminals or individual terminals in turn to at least one output pole of a pulse generator and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete the electrical circuits selected and to provide simultaneous pacing pulses to said selected combinations of terminals; (e) providing pacing pulses from said pulse generator to a selected individual terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (f) analyzing said selected electrode positions to determine their respective resultant QRS durations and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS duration is obtainable; (g) electrically connecting all said lead terminals to an implantable pulse generator incorporating noninvasive means for selective pacing through any combination of said terminals or an individual terminal, from at least one output pole and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said implantable pulse generator to complete the electrical circuits selected and to provide simultaneous pacing pulse to said selected combinations of terminals; (h) providing pacing pulses from said implantable pulse generator to a selected terminal or any selected combination of terminals, one selection at a time, at a constant rate determined to stimulate said ventricular muscle in the absence of ventricular fusion; (i) noninvasively positioning the location of the pacing pulses by employing said implantable pulse generator noninvasive means to select the combination of said terminals or an individual terminal that produces a desired QRS duration with respect to said electrode locations on said lead; (j) setting said implantable pulse generator at a desired predetermined time interval; sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; and (l) employing the first and said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to said selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval. - View Dependent Claims (8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35)
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- 24. The method of claim wherein said implantable pulse generator incorporates a rate adaptive sensor to automatically adjust said predetermined interval in response to physiologic indications of cardiac demand.
- 36. A lead adapted for connection to a pulse generator comprising at least two electrodes thereon for electrical contact with the endocardial surface of a ventricular chamber and a preformed curvature within the ventricular chamber, said preformed curvature beginning at the distal end of said lead, extending through an approximate arc of forth five degrees and having a radius of curvature of approximately one inch, for the purpose of facilitating the placement of said electrodes in desired locations by manipulation of said lead.
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38. An electrode for location on a cylindrical portion of a pacing lead in electrical contact with a ventricular chamber incorporating an outwardly curved contacting surface to improve said electrode'"'"'s pacing threshold and capability of sensing intrinsic cardiac signals.
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39. Cardiac electrical stimulation apparatus comprising:
- first means for sensing a first ventricular depolarization at a first ventricular location;
second means having output means and responsive to said first sensing means for providing a stimulating impulse to said first ventricular location upon the absence of said first depolarization within a predetermined time interval;
third means for sensing a second ventricular depolarization at a second ventricular location; and
fourth means having output means and responsive to said third means for providing a stimulating impulse to said second ventricular location upon the absence of said second ventricular depolarization within said predetermined interval and a delay interval. - View Dependent Claims (40, 41, 42, 43, 44, 45)
- first means for sensing a first ventricular depolarization at a first ventricular location;
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46. Cardiac electrical stimulation apparatus comprising:
- first means for sensing a first ventricular depolarization at a first ventricular location;
second means having output means and responsive to said first sensing means for providing a stimulating impulse to said first ventricular location upon the absence of said first depolarization within a predetermined time interval;
third means for sensing a second ventricular depolarization at a second ventricular location; and
fourth means having output means and responsive to said first and third means for providing a stimulating impulse to said second location at a programmed time delay interval from the occurrence of said first depolarization within said predetermined interval in the absence of said second depolarization within said delay interval and providing a stimulating impulse to said second ventricular location at said time delay interval from the absence of said first depolarization within said predetermined interval in the absence of said second ventricular depolarization within said delay interval. - View Dependent Claims (47, 48, 49, 50, 51, 52, 53, 54, 55, 56)
- first means for sensing a first ventricular depolarization at a first ventricular location;
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57. A method for improving the ventricular function of the heart of a patient, presenting with wide QRS complexes of intrinsic origin, comprising the steps of:
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(a) monitoring the electrocardiogram of a patient to determine the duration of the patient'"'"'s QRS complex; (b) introducing a lead incorporating at least two electrodes of the same polarity thereon for electrical contact with ventricular muscle, each electrode electrically connected to a different lead terminal; (c) manipulating said lead to position at least two of said electrodes in electrical contact with said ventricular muscle; (d) electrically connecting at least two of said individual terminals to at least one output pole of a pulse generator and electrically connecting at least one electrical ground location, of polarity opposite to that of said electrodes, to the other pole of said pulse generator in order to complete each electrical circuit; (e) sensing intrinsic cardiac signals from at least one said terminal during a cardiac cycle; (f) employing the first of said cardiac signals in the electronic control circuit of said pulse generator to trigger the deliverance of pacing pulses to selected terminals simultaneous with the occurrence of said first intrinsic signal within a predetermined time interval and cause the deliverance of simultaneous pacing pulses to said selected terminals upon the absence of any said cardiac signal within said predetermined time interval; (g) providing pacing pulses from said pulse generator to at least one other selected terminal at a rate determined by intrinsic electrical activity in order to stimulate said ventricular muscle in the presence of ventricular fusion; (h) analyzing said electrode positions to determine their respective resultant QRS duration as compared to the intrinsic QRS duration and, if desired, further manipulating said lead to re-position said electrodes and analyzing such new positions to determine if a shorter resultant QRS is obtained; and (j) providing pacing pulses from said pulse generator to a desired combination of terminals that produces a shorter QRS duration than the patient'"'"'s intrinsic QRS.
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Specification