Method and apparatus for rate-responsive cardiac pacing using header mounted pressure wave transducer
First Claim
1. In a rate-responsive cardiac pacemaker, a system for deriving a physiologic signal related to the metabolic demand for cardiac output as a function of pressure waves within the patient'"'"'s body and deriving a pacing rate control signal therefrom for setting a pacing rate to satisfy the metabolic demand for cardiac output comprising:
- an elongated pacing lead comprising;
an elongated lead body extending between a proximal connector end and a distal end adapted to be placed in association with the heart and adapted to conduct body pressure waves to the proximal connector end thereof;
a pace/sense electrode at the distal end of said lead body; and
a pace/sense lead conductor within said lead body extending between said proximal connector end and said pace/sense electrode for conducting pacing pulses from said proximal connector end to said pace/sense electrode and for conducting electrogram heart signals from said pace/sense electrode to said proximal connector end; and
a cardiac pacemaker pulse generator comprising;
a connector assembly for attachment with said proximal connector end;
a pressure wave transducer mounted in said connector assembly in relation to said proximal connector end for detecting said pressure wave through said lead body using a solid mechanical linkage to said transducer and for providing a pressure wave signal;
pressure wave signal processing means responsive to said pressure wave signal for determining a physiologic signal related to the metabolic demand for cardiac output;
rate setting means responsive to said physiologic signal for determining a pacing rate to meet the metabolic demand for cardiac output; and
a pulse generator for generating and delivering a pacing pulse through said connector assembly and said proximal connector end connected thereto to said pace/sense electrode at said pacing rate.
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Accused Products
Abstract
In a pacemaker, a method and apparatus for providing rate response in proportion to the patient'"'"'s metabolic demand for cardiac output as determined in response to the patient'"'"'s breathing rate or respiratory minute ventilation or contraction strength, optionally augmented by the patient'"'"'s activity level. An implantable pulse generator (IPG) has one or more pacing leads having a proximal end coupled to the IPG and a distal end in contact with a patient'"'"'s heart. A pressure wave transducer mounted in the IPG in relation to the proximal end of the pacing lead senses pressure waves transmitted from the distal end of the pacing lead to the proximal end thereof. The pressure waves originate from disturbances imparted to the lead by heart contractions and breathing. A further isolated, reference sensor is also incorporated into the IPG in a similar fashion. An activity signal processor is coupled to the pressure wave or reference sensor for providing a patient activity physiologic signal. A respiration signal processor is coupled to said pressure wave and reference transducers for nulling out common mode noise and providing physiologic respiration rate and/or respiratory minute ventilation signals. A contraction strength signal processor is coupled to said pressure wave and reference transducers for nulling out common mode noise and providing physiologic contraction strength signals. Pacing rate control circuitry is responsive to one or more of the physiologic signals for setting the pacing rate to meed the metabolic demand.
228 Citations
15 Claims
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1. In a rate-responsive cardiac pacemaker, a system for deriving a physiologic signal related to the metabolic demand for cardiac output as a function of pressure waves within the patient'"'"'s body and deriving a pacing rate control signal therefrom for setting a pacing rate to satisfy the metabolic demand for cardiac output comprising:
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an elongated pacing lead comprising;
an elongated lead body extending between a proximal connector end and a distal end adapted to be placed in association with the heart and adapted to conduct body pressure waves to the proximal connector end thereof;
a pace/sense electrode at the distal end of said lead body; and
a pace/sense lead conductor within said lead body extending between said proximal connector end and said pace/sense electrode for conducting pacing pulses from said proximal connector end to said pace/sense electrode and for conducting electrogram heart signals from said pace/sense electrode to said proximal connector end; and
a cardiac pacemaker pulse generator comprising;
a connector assembly for attachment with said proximal connector end;
a pressure wave transducer mounted in said connector assembly in relation to said proximal connector end for detecting said pressure wave through said lead body using a solid mechanical linkage to said transducer and for providing a pressure wave signal;
pressure wave signal processing means responsive to said pressure wave signal for determining a physiologic signal related to the metabolic demand for cardiac output;
rate setting means responsive to said physiologic signal for determining a pacing rate to meet the metabolic demand for cardiac output; and
a pulse generator for generating and delivering a pacing pulse through said connector assembly and said proximal connector end connected thereto to said pace/sense electrode at said pacing rate. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
said pressure wave transducer is responsive to lead body pressure waves reflecting lead body motion caused by the contraction of the patient'"'"'s heart and provides said pressure wave signal having contraction frequency and amplitude components representative thereof; and
said pressure wave signal processing means provides a heart contraction strength signal in response to said contraction frequency and amplitude components of said physiologic signal.
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3. The system of claim 1 wherein:
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said pressure wave transducer is responsive to lead body pressure waves reflecting lead body motion caused by the breathing of the patient and provides a pressure wave signal having respiration frequency and amplitude components representative thereof; and
said pressure wave signal processing means provides a respiration rate signal in response to said respiration frequency and amplitude components of said physiologic signal.
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4. The system of claim 1 wherein:
said pressure wave transducer is responsive to lead body pressure waves reflecting lead body motion caused by the breathing of the patient and provides a physiologic pressure wave signal having respiration frequency and amplitude components representative thereof; and
said pressure wave signal processing means provides a respiratory minute ventilation signal from the respiration frequency and amplitude components of said physiologic pressure wave signal.
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5. The system of claim 1 wherein said pressure wave detection transducer comprises a miniaturized accelerometer.
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6. The system of claim 1 further comprising:
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a reference transducer mounted in said connector assembly and isolated from said proximal connector end for detecting common mode noise signals and providing a reference signal in response thereto; and
means for processing said signal and said pressure wave signal for removing common mode noise and detecting pressure waves associated with said body site.
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7. The system of claim 6 wherein said pressure wave detection transducer is affixed within said connector assembly so as to be adapted and disposed to ensure direct physical contact with said proximal connector end, for the transfer of said pressure waves through said direct physical contact.
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8. The system of claim 1 wherein:
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said pressure wave transducer is responsive to lead body pressure waves reflecting lead body motion caused by the activity of the patient and provides a pressure wave signal having activity frequency and amplitude components representative thereof; and
said pressure wave signal processing means provides an activity signal in response to said activity frequency and amplitude components of said pressure wave signal of said physiologic signal.
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9. The system of claim 8 further comprising a reference transducer isolated from mechanical linkage to said lead body.
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10. The system of claim 9 wherein said pressure wave detection transducerand said reference transducer are piezoelectric crystal transducers.
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11. In a rate-responsive cardiac pacemaker, a system for deriving a pacing rate control signal from physiologic signals related to the metabolic demand for cardiac output for setting a pacing rate to satisfy the metabolic demand for cardiac output comprising:
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an elongated pacing lead comprising;
an elongated lead body extending between a proximal connector end and a distal end adapted to be placed in association with the heart and adapted to conduct body pressure waves to the proximal connector end thereof;
a pace/sense electrode at the distal end of said lead body; and
a pace/sense lead conductor within said lead body extending between said proximal connector end and said pace/sense electrode for conducting pacing pulses from said proximal connector end to said pace/sense electrode and for conducting electrogram heart signals from said pace/sense electrode to said proximal connector end; and
a cardiac pacemaker pulse generator comprising;
a connector assembly for attachment with said proximal connector end;
a pressure wave transducer mounted in said connector assembly and attached through a solid mechanical linkage to said proximal connector end for detecting said pressure wave and providing a pressure wave signal;
pressure wave signal processing means responsive to said pressure wave signal for determining a first physiologic signal related to the metabolic demand for cardiac output;
activity sensing means for sensing patient activity pressure waves and providing an activity signal;
activity signal processing means responsive to said activity signal for determining a second physiologic signal related to the activity related metabolic demand for cardiac output;
rate setting means responsive to the first and second physiologic signals for determining a pacing rate to meet the metabolic demand for cardiac output; and
a pulse generator for generating and delivering a pacing pulse through said connector assembly and said proximal connector end connected thereto to said pace/sense electrode at said pacing rate. - View Dependent Claims (12, 13, 14)
said pressure wave transducer is responsive to lead body pressure waves reflecting lead body motion caused by the contraction of the patient'"'"'s heart and provides said pressure wave signal having contraction frequency and amplitude components representative thereof;
said pressure wave signal processing means provides a heart contraction strength signal in response to said contraction frequency and amplitude components; and
said rate setting means is responsive to said heart contraction strength signal and said second physiologic signal for determining the pacing rate.
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13. The system of claim 11 wherein:
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said pressure wave transducer is responsive to lead body pressure waves reflecting lead body motion caused by the breathing of the patient and provides a pressure wave signal having respiration frequency and amplitude components representative thereof;
said signal processing means provides a respiration rate signal in response to said respiration frequency and amplitude components; and
said rate setting means is responsive to said respiration rate signal and said second physiologic signal for determining the pacing rate.
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14. The system of claim 11 wherein:
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said pressure wave transducer is responsive to lead body pressure waves reflecting lead body motion caused by the breathing of the patient and provides a pressure wave signal having respiration frequency and amplitude components representative thereof;
said signal processing means provides a respiratory minute ventilation signal from the respiration frequency and amplitude components of the pressure wave; and
said rate setting means is responsive to said respiratory minute ventilation signal and said second physiologic signal for determining the pacing rate.
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15. In a rate-responsive cardiac pacemaker, a system for deriving a pacing rate control signal from physiologic signals related to the metabolic demand for cardiac output for setting a pacing rate to satisfy the metabolic demand for cardiac output comprising:
- an elongated pacing lead comprising;
an elongated lead body to be placed in association with the heart and adapted to conduct body pressure waves to the proximal connector end thereof;
a pace/sense electrode at the distal end of said lead body; and
a pace/sense lead conductor within said lead body extending between a proximal connector end and a distal end adapted extending between said proximal connector end and said pace/sense electrode for conducting pacing pulses from said proximal connector end to said pace/sense electrode and for conducting electrogram heart signals from said pace/sense electrode to said proximal connector end; and
a cardiac pacemaker pulse generator comprising;
a connector assembly for attachment with said proximal connector end;
a pressure wave transducer mounted in said connector assembly and being in mechanical linkage to said proximal connector end for detecting said pressure wave and providing a pressure wave as transmitted by said lead body signal;
ressure wave signal processing means responsive to said pressure wave signal for determining a first physiologic signal related to the metabolic demand for cardiac output;
activity sensing means for sensing patient activity pressure waves and providing an activity signal;
said activity signal processing means is responsive to said activity frequency and amplitude components of said activity signal for providing said second physiologic signal;
rate setting means responsive to the first and second physiologic signals for determining a pacing rate to meet the metabolic demand for cardiac output; and
a pulse generator for generating and delivering a pacing pulse through said connector assembly and said proximal connector end connected thereto to said pace/sense electrode at said pacing rate.
- an elongated pacing lead comprising;
Specification