Mechanical ventricular pacing capture detection for a post extrasystolic potentiation (PESP) pacing therapy using at least one lead-based accelerometer

• US 8,738,131 B2
• Filed: 03/20/2007
• Issued: 05/27/2014
• Est. Priority Date: 03/20/2007
• Status: Expired due to Fees

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Chinchoy, Edward, Hess, Michael F.
• Primary Examiner(s): Heller, Tammie K
• Application Number:
  US11/688,515
• Publication Number:
  US 20080234771A1
• Time in Patent Office: 2,625 Days
• Field of Search: 607/11, 607/28, 600/510
• US Class Current: 607/28
• 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 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold

Abstract

A system and method for monitoring at least one chamber of a heart (e.g., a left ventricular chamber) during delivery of extrasystolic stimulation to determine if the desired extra-systole (i.e., ventricular mechanical capture following refractory period expiration) occurs. The system includes an implantable or external cardiac stimulation device in association with a set of leads such as epicardial, endocardial, and/or coronary sinus leads equipped with motion sensor(s). The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of chamber capture resulting from one or more pacing stimulus delivered closely following expiration of the refractory period. A threshold optimization method optionally evaluates capture and at least one of: runs an iterative routine to establish or re-establish chamber capture for the PESP therapy, sets a logical flag relating to chamber capture status and stores parameter(s) relating to successful chamber capture for one or more subsequent cardiac cycles.

Claims

1. An apparatus for LV (Left Ventricular) pacing stimulus delivery resulting in augmented stroke volume, comprising:

transducing means for measuring movement of a portion of the lateral wall of a LV and providing a movement signal related to such movement;

a movement measurement circuit operatively coupled to the transducing means;

a pulse generator coupled to the measurement circuit;

a left pacing electrode in electrical communication with a portion of the LV and electrically coupled to a post extrasystolic potentiation (PESP) pacing circuit of the pulse generator;

an LV movement threshold circuit coupled to the transducing means and responsive to the movement signal and adapted to generate a signal indicating a successful post extrasystolic depolarization LV pacing parameter; and

a programmable circuit coupled to the threshold circuit and the pulse generator and programmed to modify LV pacing parameters until the signal indicative of a successful PESP LV pacing parameter is generated by the threshold circuit.

2. An apparatus according to claim 1, wherein the pulse generator comprises an implantable pulse generator.

3. An apparatus according to claim 1, wherein the pulse generator further comprises at least one defibrillation electrode in electrical communication with at least one chamber of a heart and high-voltage circuitry disposed within the pulse generator.

4. An apparatus according to claim 1, wherein the transducing means comprises an accelerometer and said left pacing electrode is coupled to said accelerometer.

5. An apparatus according to claim 1, wherein the transducing means comprises an accelerometer.

6. An apparatus according to claim 1, wherein the portion of the lateral wall is a mid-basal portion of the lateral wall.

7. An apparatus according to claim 6, wherein the portion of the left ventricle is a one of:

an epicardial portion, an endocardial portion, a pericardial portion.

8. An apparatus for LV (Left Ventricular) pacing stimulus delivery resulting in augmented stroke, comprising:

transducing means for measuring movement of a portion of the lateral wall of a LV and providing a movement signal related to such movement;

a movement measurement circuit operatively coupled to the transducing means;

a pulse generator coupled to the measurement circuit;

a left pacing electrode in electrical communication with a portion of the LV and electrically coupled to a post extrasystolic potentiation (PESP) pacing circuit of the pulse generator;

an LV movement threshold circuit coupled to the transducing means and responsive to the movement signal and adapted to generate a logical flag signal a logical flag indicative of LV PESP pacing-induced capture, and

a programmable circuit coupled to the threshold circuit and the pulse generator and programmed to modify LV pacing parameters until the flag indicative of LV PESP pacing induced capture is generated by the threshold circuit.

9. An apparatus according to claim 8, wherein the pulse generator comprises an implantable pulse generator.

10. An apparatus according to claim 8, wherein the pulse generator further comprises at least one defibrillation electrode in electrical communication with at least one chamber of a heart and high-voltage circuitry disposed within the pulse generator.

11. An apparatus according to claim 8, wherein the transducing means further comprises an accelerometer and said left pacing electrode is coupled to said accelerometer.

12. An apparatus according to claim 8, wherein the transducing means comprises an accelerometer.

13. An apparatus according to claim 8, wherein the portion of the lateral wall is a mid-basal portion of the lateral wall.

14. An apparatus according to claim 13, wherein the portion of the left ventricle is a one of:

an epicardial portion, an endocardial portion, a pericardial portion.