US20090192561A1 - On-again, off-again physiologic-demand heart pacing - Google Patents
On-again, off-again physiologic-demand heart pacing Download PDFInfo
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- US20090192561A1 US20090192561A1 US12/321,650 US32165009A US2009192561A1 US 20090192561 A1 US20090192561 A1 US 20090192561A1 US 32165009 A US32165009 A US 32165009A US 2009192561 A1 US2009192561 A1 US 2009192561A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/36585—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by two or more physical parameters
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
- A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
- A61N1/36578—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
Abstract
A method of intentional on-again, off-again physiologic-demand heart pacing associated with at least one of (a) an implantable, and (b) an external, controllable/adjustable heart-pacing device having on and off states. The method involves gathering categories of a person's physiologic data, including ECG and heart-sound data, which are (a) relevant to that person's heart's pumping and filling functionalities, and (b) suitable for computing a selected acoustic cardiographic value; and based on such gathering and computing, and using a controlled combination of on and off states in the pacing device, recurrently adjusting the operation of that device, as necessary, so as to maintain a minimum difference between such a computed acoustic cardiographic value and a predetermined, reference acoustic cardiographic value.
Description
- This patent application is related to and claims priority from U.S. Provisional Patent Application Ser. No. 61/062,702, filed Jan. 29, 2008, for Stage-Monitored Physiologic-Demand Heart Pacing, and also relates to subject matter which can be found in U.S. patent application Ser. No. 11/264,328, filed Nov. 1, 2005 for Hemodynamic Assessment/Adjustment, U.S. patent application Ser. No. 11/442,467, filed May 25, 2006, for Cardio-Function Cafeteria System and Methodology, and in U.S. Pat. No. 7,174,203 B1, granted Feb. 6, 2007, for Method and System Relating to Monitoring and Characterizing Heart Condition. These application and patent documents are fully are incorporated herein by reference.
- The instant invention is associated generally with the field of acoustic cardiography, and more specifically relates to controlling physiologic-on-demand, feedback-adjusted heartbeat-assist pacing in a heart-pacing therapy-device-equipped patient (such as a pacemaker-equipped patient) specifically through controlling the on-again, off-again heartbeat pacing behavior, or pacing pattern, of such a device. I refer herein to such a practice as physiologic-demand pacing. Those skilled in the art will recognize that this field of acoustic cardiography involves the cooperative, information-integration use of both heart sounds and ECG information processed in different ways to obtain, selectively, various important heart-functionality parameters which correlate to, and help one to understand, the hemodynamic (pumping and filling) behavior(s) of a subject's heart. Such integration characterizes and underpins important aspects of the present invention.
- While it will be very evident to those skilled in the art that the methodology of the present invention may be employed successfully in a number of different heart-pacing therapy device manners of operation, a preferred and best-mode approach toward practicing the invention is disclosed herein, for illustration purposes, specifically in the context of biventricular, pacemaker pacing. As will be seen, this implementation of the invention focuses, in the related context of feedback-adjusted heart-therapy pacing, on the development and defining (computer calculation) of what is referred to herein as an acoustic cardiographic (AC) control value (also referred to as a physiologic-demand AC control value, and also as an AC Value). This AC Value “entity”, utilizing computer processing, is determined from (i.e., is based upon) one or more heart-functionality parameter(s) that are especially relevant to the heart pumping and filling functions, and is computed on the basis of key, input, physiologic information, such as heart-sound and ECG information. In this setting, the invention specifically recognizes the special, differential utility, in various circumstances, of several, important heart-functionality parameters as bases for calculating, and then employing, AC Values that are deemed to be the most useful for controlling, in an on-again/off-again sense, and in relation to the mentioned heart pumping and filling functions, the pacing operation of a (heart-therapy-device) pacemaker. These parameters are four in number. They include % LVST, S3, S4 and EMAT.
- In certain circumstances, the % LVST parameter may be used as an averaged singularity for AC-Value calculation purposes. In certain other circumstances, an averaged (per parameter) and mathematically combined (both parameter averages), two-parameter combination of the S3 and EMAT parameters may be approach the most relevant for use. Still further instances may be best addressed by using other averaged and mathematically combined combinations of the four, mentioned parameters. Those skilled in the relevant medical arts will understand how to choose AC-Value basing parameters from the detailed description of the invention which is follows shortly. Non-exclusive illustrations of averaging and mathematical combining of heart-functionality parameter values involved in the calculation of AC values are given below.
- At this point, it will be useful to define certain terms and terminology which appear(s) in the text herein.
- S1—The peak-to-peak measurement of the amplitude of the first heart sound (based predominantly on mitral valve closure).
- S2—The peak-to-peak measurement of the amplitude of the second heart sound (based predominantly on aortic valve closure).
- S3—The strength of the third heart sound based on the intensity and persistence of that sound. Conventionally, acoustic cardiography provides a value for S3 strength in the range of 1 to 10. If this value equals or exceeds 5.0, a conventional algorithm employed herein declares that a third heart sound is present. With relatively normal heart rates, the third heart sound occurs typically about 0.12- to about 0.16-seconds after the second heart sound. The most likely explanation for the production of the third heart sound is that vigorous and excessively rapid filling of blood into a stiff ventricle is suddenly halted, causing audible vibrations. In persons generally older than about 40-years, the third heart sound has been shown to indicate elevated filling pressure and systolic dysfunction. This S3 sound is associated with an abnormal diastolic filling pattern, and almost all persons with pseudonormal, or restrictive, filling patterns exhibit third heart sounds.
- S4—The strength of the fourth heart sound based on the intensity and persistence of that sound. Conventionally, acoustic cardiography provides a value for S4 strength in the range of 1 to 10. The fourth heart sound occurs after T-wave onset and before the first heart sound in a cardiac cycle. The S4 sound occurs as blood enters a relatively non-compliant ventricle late in diastole because of atrial contraction, resulting in vibrations of (a) the left ventricular muscle, (b) the mitral valve structure, and (c) the left ventricular blood mass often associated with left ventricular hypertrophy due to the decreased compliance and frequency present in acute myocardial infarction. The presence of the fourth heart sound is always abnormal.
- % OLVST—Left ventricular systolic time measured as the time from the mitral component of the first heart sound to the aortic component of the second heart sound. % LVST is computed as LVST divided by the dominant RR interval (the time between two consecutive R waves in an ECG signal). % LVST indicates how much of the cardiac cycle is occupied by systole (pump function) versus diastole (filling). A normal % LVST value lies usually in the range of about 35% to about 45%.
- EMT—The electromechanical activation time measured from Q-wave onset (from ECG information) to the time of closure of the mitral valve within the first heart sound. The time value of EMAT reflects the time required for the left ventricle to generate sufficient force to close the mitral valve, and is therefore related to the acceleration of the pressure curve in the left ventricle.
- Time for Off State—A user-selected, predetermined time interval which is begun and measured from the beginning of each time that a heart-pacing therapy device enters a sustained On State. It marks a time for switching that device from a sustained On State to an Off State, at least temporarily, in order to make a determination about whether the device should be turned back to the On State to continue applying therapy, or whether a subject's heart behavior at that point in time is such that the device may be left in an Off State for another, user-selected, predetermined, sustained period of time.
- Time for On State—A user-selected, predetermined time interval which is begun and measured from the beginning of each time that a heart-pacing therapy device enters a sustained Off State. It marks a time for switching that device from a sustained Off State to an On State, at least temporarily, in order to make a determination, based upon a subject's then actual heart behavior, about whether the device should now remain in a sustained On State to resume therapy, or whether a subject's heart behavior at that point in time is such that the device may be returned to an Off state, or in certain instances, simply held in the existing on off state.
- AC Value—While other approaches may be made if desired, an AC Value herein, generally, is a computer-calculated, numeric value based upon simple, common-parameter averaging, and arithmetic combining (adding, subtracting, multiplying, etc. of the respective, common-parameter averages associated with plural, different parameters), of the determined values of user-selected parameters (one or more) drawn from the list of the four, heart-functionality parameters mentioned above, acquired over a user-selected, cardiac-cycle-collection time period, such as a ten-second time period.
- As an illustration, if two heart-functionality parameters (as distinguished from a singular, selected-parameter situation), A and B, have been selected to form the basis for a calculated AC Value, the respective A and B values obtained from the plural heart cycles acquired during a given cardiac-cycle-collection time period are individually averaged to produce an average A value and an average B value. These two, average, parameter-specific values are then mathematically combined as desired, for example by addition, subtraction, multiplication, etc., to produce a resulting, usable AC Value. If desired, in such a plural-parameter use situation, weighted mathematical combining may be employed to recognize differential importances relating to the selected heart-functionality parameters.
- Actual AC Value—an AC Value which is calculated, in real-time, based upon a selected number of cardiac cycles acquired from a subject during implementation and operation of the methodology of the invention.
- Reference AC Value—an AC Value based upon one or more of the four, mentioned, selected heart-functionality parameters, determined from data acquired from a subject at a point in time when that subject's heart appears to be operating in a normal and satisfactory manner. A Reference AC Value may also be drawn from an available database of heart-functionality data derived from a selected population of people having characteristics which are deemed to be similar to those possessed by a particular subject.
- Cardiac Resynchronization Therapy (CRT) is an effective method to decrease morbidity and mortality, and to increase quality of life in patients having severe and moderate heart failure and mechanical dyssynchrony. The implantation of a biventricular pacemaker as a heart-pacing therapy device in such patients leads to more synchronous, simultaneous contraction patterns of the right and left ventricle, and, assuming good placement of the relevant ventricular pacing lead, and optimized pacemaker settings, to an improvement in systolic performance of the heart. Such an improvement may be measured by improvements in left ventricular ejection fraction, end-diastolic volume, end-systolic volume, and end-diastolic pressure. The practice of assisting heart functionality is, of course, known to be possible through the supportive use of other aiding devices and practices, depending on the underlying root cause, or causes, for severe systolic dysfunction. Illustrations of such other devices and methods include: (a) Left Ventricular Assist Devices (LVAD) for patients with severely failing hearts waiting for heart transplants; (b) Cardiac Contractility Modulation (CCM) with very low systolic strength and no dyssynchrony; and (c) External Counter Pulsation Therapy (ECPT); etc.
- At the present time, the duration for which a heart failure therapy is applied to the patient is completely empirical, and is based on a subjective assessment by the attending physician. In the case of CRT, the therapy is enabled and continued 100% after its initiation, independent of whether the therapy will change heart structure or the need for continuous activation. This independence ignores the fact that finer, more precise control over, and knowledge about, the actual time(s) that good heart functionality is made, or is, dependent upon therapy pacing, may frequently offer a much improved, overall heart-behavior condition for a heart-failure subject.
- The present invention, as will be seen, avoids these prior-practice “non-independence” conditions and practices effectively by applying objectively controlled, thoughtfully staged, cardio-functionality therapy—and specifically, controlled, pacemaker (heart-pacing device) “duration” therapy—on the basis of certain, selected, key-relevance, carefully assessed cardio-function parameters.
- In general terms, the present invention furnishes a therapy-duration control method involving intentional on-again, off-again, physiologic-demand heart pacing which is associated with at least one of an operationally adjustable (a) implantable, and (b) external, controllable/adjustable heart-pacing device having on and off states (On State, Off State). It is especially aimed at furnishing, through such control, an effective approach toward decreasing morbidity and mortality, and thereby increasing quality of life, in patients having severe and moderate heart failure and mechanical dyssynchrony (important heart-failure issues). The invention methodology leads significantly to control over the operation of a heart-pacing device in a manner which directly leads to more synchronous, simultaneous contraction patterns of the right and left ventricle, thus to result in an improvement in systolic performance of the heart, as reflected strongly by improvements made in left ventricular ejection fraction, in end-diastolic volume, in end-systolic volume, and in end-diastolic pressure.
- The method of the invention includes the practice of gathering certain, selected categories of a person's physiologic data, including both ECG and heart acoustic data, which are (a) relevant to that person's heart functionality in the areas of concern expressed above, and (b), suitable for computing and producing an actual, heart-functionality-parameter-based, acoustic, cardiographic therapy-control (AC) value. Based on the gathered data, and using a controlled, feedback-associated combination of On and Off states in a heart-pacing device, the methodology of the invention involves recurrently adjusting the operation of that device, including adjusting the device's specific operational performance (pacing rate, pacing intensity, atrio-ventricular (AV) delay, and inter-ventricular (IV) delay) in the On State, as necessary (i.e., in an on-needed manner as will be explained herein), so as to maintain a minimum difference between such an actual AC Value, and a predetermined, reference AC Value.
- In a more specific sense the present invention involves an intentional, staged on/off, physiologic-demand heart-pacing methodology using acquired ECG and heart-sound information for operationally adjusting, and for controlling the on and off states of, an implanted or external heart-pacing therapy device associated with a subject having heart failure, including the steps of: (a) selecting at least one of the heart-functionality parameters % LVST, S3, S4 and EMAT to form a basis for a calculated, acoustic cardiographic therapy (AC) value which is to be employed in relation to such adjusting and controlling; (b) based on the selecting step, establishing a desired, reference, AC Value; (c) monitoring real-time, subject ECG and heart-sound information, and periodically calculating therefrom actual AC values; (d) utilizing various, different comparisons between the actual and reference AC Values, and employing a selected feedback loop approach, controlling both (1) the On-State/Off-State status of the therapy device in a pattern of On-State and Off-State conditions, and (2) the On-State, adjusted operational pacing-rate, pacing intensity, AV delay and/or IV delay behaviors of that device, in an overall manner aimed at both (i) maintaining a minimum difference between the actual and the reference AC Values, and (ii) maximizing Off-State time in the therapy device; and (e), by such utilizing and controlling, effecting a heart-functionality-based, on-demand, therapy relationship between the subject's heart and the therapy device, wherein heart-functionality is maximized, and therapy-based heart functionality control is minimized.
- In a somewhat more specific sense with respect to the calculating of an actual AC Value, and in certain, but not all, instances, the computer processing step is performed so as to obtain specifically either the % LVST heart-functionality parameter as a singularity, or the two-parameter, heart-functionality combination of S3 and EMAT as a duality. In other instances, all four of the mentioned heart-functionality parameters are employed, and in still further situations, other parameter combinations of the four, mentioned heart-functionality parameters may be used. From the descriptions of the invention given herein, those skilled in the relevant medical arts will, from observation of a particular person, and from experience, be able readily to choose which parameter or parameters to obtain, process, use for AC-Value calculation, and employ.
- The predetermined, reference AC Value may, selectively, be based upon heart-functionality parameter information derived either from (a) a selected population of people, or from (b) previously acquired, subject-specific, heart-functionality information.
- The methodology of the invention may further be expressed, in relation to employing the mentioned reference-comparison practice, as intervalically performing the gathering, computer-processing, and defining steps, and thereby intervalically adjusting the respective durations of the mentioned on and off states.
- A more thorough understanding of the invention will be obtained by reference to the following detailed description of the preferred and best-mode embodiment of the invention in connection with the accompanying drawings.
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FIG. 1 is a graphical, time-based presentation of ECG data, heart sounds, certain heart functions, and aspects of several parameters which are relevant to practice of the present invention. -
FIG. 2 is a block/schematic diagram illustrating the overall methodology of the present therapy-duration-control invention. In particular, this figure illustrates an interruptible, operational-adjustment feedback loop which is specifically employed, when not interrupted in accordance with certain steps of the invention to enter a period of time for placing a heart-pacing therapy device in an Off State, for applying adjustments in the operation of the therapy device in accordance with determinations that are made regarding whether such an adjustment is necessary at the current time to improve detected heart functionality, and specifically, heart pumping and filling functionalities. -
FIG. 3 is a block/schematic diagram picturing a portion of another feedback loop arrangement which relates partially to a block labeled “Time for Off State” illustrated inFIG. 2 , specifically focused upon testing whether a switch of the heart-pacing therapy device from and On State to an Off State for a period of time is appropriate. -
FIG. 4 is a block/schematic diagram which is associated withFIG. 3 , and which completes an illustration of the mentioned, other feedback loop arrangement, in this case, illustrating whether, with a heart-pacing therapy device “currently” in an Off State, it would be better, or not, at this point in time to switch the therapy device to an On State. - The methodology of the present, physiologic-demand pacing invention, while illustrated and specifically described herein in a setting for furnishing therapy-duration control over a biventricular pacemaker, is not limited to that particular heart-therapy device configuration and modality, and, as will be appreciated by those skilled in the art, may be applied to any one of a number of different heart-failure, heart-pacing-device therapies which lead to improvements in systolic performance, i.e., regular dual-chamber pacing, CCM, LVAD, ECPT, etc. This versatile methodology, as will be seen, uses selected physiologic parameter(s), and frequently, though not always, only one parameter (% LVST) in particular, extracted from a computerized analysis of simultaneously acquired electrocardiograms (ECGs or IEGMs) and heart sound recordings, as the (or a) central control parameter(s) relied upon to effect control over the operation of an implanted or external cardiac heart-pacing device. These parameters “operate” effectively, through computer processing, to define, through calculation, what is referred to herein as a physiologic-demand, acoustic cardiographic (AC) control value (the earlier-mentioned AC Value) which control value more directly ( than the specific underlying parameters, per se) applies pacing control to a relevant heart-pacing device, such as a pacemaker. All aspects of the invention are focused on addressing the heart-failure pumping and filling issues specifically referred to above.
- Turning now to the drawings, and beginning with
FIG. 1 , for those who are generally skilled in the relevant art, the content of the time-based graphical display which is presented in this figure is completely familiar, and requires no particular elaboration. As will be observed, this content plainly illustrates the characteristics of the several, particular, different heart-functionality (physiologic) parameters, both electrical and acoustical, which differentially play roles in the AC-Value defining (calculating) practice of the present invention. These parameters, whose respective definitional characteristics which are relevant herein have been set forth above, include S1, S2, S3, S4, % LVST, and EMAT. - Switching attention to
FIG. 2 , indicated generally at 10 is a block/schematic diagram which illustrates the overall architectural layout, and the key features, of the methodology of the present invention.Methodology 10 is specifically illustrated and described herein in the context of a person—a subject—(not specifically illustrated in the drawings) who has a heart-failure (poor pumping and filling) condition, and who has been equipped with a heart-pacing device in the form of a biventricular pacemaker. Such a device may be either an implanted (internal) device, or an external device, with respect to which the features of the present invention are equally applicable. However, for invention description purposes herein, an assumption is made that such a device is of the implanted, internal category. - Also in connection with the discussion of the invention which is now to unfold, we will assume that the pacemaker which has been implanted in the mentioned subject is initially operating in an On State. More specifically we will assume that the pacemaker is effectively currently operating at the beginning of what is referred to herein as a sustained, On-State operating period whose length has been predetermined by the user, and which State will, as will shortly be explained, be terminated, at least temporarily, to place the pacemaker in an Off State for the purpose of determining whether the pacemaker should be returned to the On State, or left for another user-predetermined span of time during which it will remain in a sustained Off-State condition. The user-predetermined lengths of these mentioned, sustained On-State/Off-State time intervals, as referred to herein, are not critical to an understanding of the invention, are completely user chooseable and changeable as desired, and are programmed into a computer C (shown in
FIG. 2 , and mentioned more particularly below), in accordance with what appears to the user to be in the best interest of a particular subject. Accordingly, they are not discussed herein in any special detail. - Continuing with a discussion regarding
FIG. 2 , shown more specifically at 10 are a preferred, and best-mode, embodiment of, and manner of practicing, the methodology of the present invention. As shown inFIG. 2 ,methodology 10 includes sevenblocks lines -
Block 12 represents the mentioned, non-illustrated-subject's heart, and block 14 represents a heart-pacing therapy device in the form, as just suggested above, of a biventricular pacemaker. Pacing pulses are delivered frompacemaker 14 toheart 12 viacommunication connection 28. - Blocks 16-24, inclusive, represent both structure and methodology which is implemented in an appropriately, and conventionally, algorithmically programmed digital computer (mentioned briefly above). Thus these five blocks may be understood in
FIG. 2 to represent directly such a computer, and a bracket C appearing adjacent the right side ofFIG. 2 represents such a computer. This same bracket may also be viewed herein as encompassing, and in part representing, an optional modification of the invention which involves the user-elective presence of a particular kind of operative association betweenpacemaker 14 and the mentioned computer, whereby specific information relating to certain operational parameters of the pacemaker, such as the above-mentioned pacing rate, pacing intensity, atrio-ventricular (AV) delay time, and inter-ventricular (IV) delay time operational parameters, may be fed back to the computer to indicate their respective statuses, and further to offer augmented utility in the practice of the invention. - Algorithmic programming in computer C, which programming includes, as will be seen, an architecture that is suitable for implementing all of the still-to-be-described, (a) timing-control, (b) pacing-device control, and (c) value-calculation tasks, as well as any other computational tasks that may be desired, may be structured in various different, entirely conventional ways that are all well within the skills and knowledge possessed by those generally skilled in such programming arts. This condition of readily understandable programming suited to the practice of the present invention is especially is made clear in the contexts of the teachings of the drawings presented herein, and of the operational description of the invention set forth below. Accordingly, programming details, and details of related algorithmic architecture associated with, and installed in, computer C, which details form no part of the present invention, are not elaborated herein.
- Received in
block 16, as delivered viacommunication connection 30, are ECG and heart-sound categories of information (heart-functionality information) that are acquired in conventional fashions fromheart 12. One should note here that the present invention is not concerned with any specific manner or manners in which such heart-functionality information is acquired, and, accordingly, no specific details of such acquisition are set forth herein. Suffice it to say that each “event” of gathering such information takes place over a user-selectable, pre-determined, and pre-computer-programmed interval of time—the previously mentioned, illustrative cardiac-cycle-collection time period of ten-seconds—which is sufficient to permit the capture of heart data from a suitable plurality of real-time, i.e., current, cardiac cycles. For the purpose only for illustration herein, an assumption is made that ten cardiac cycles are acquired during each cardiac-cycle-collection time period of ten-seconds. -
Block 16, which is labeled “Monitor and Calculate Actual AC Value”, receives and processes this ECG and heart-sound received information to calculate and identify per-cardiac-cycle values for whichever one or ones of the four, above-identified, heart-functionality parameters has been chosen by a user to be employed in the practice of this invention for effecting pacing control over the operation ofpacemaker 14. For the purpose of ongoing description of the invention methodology herein, and just for single-illustration purposes, we will further assume that the parameter % LVST has been chosen as a singularity to form the basis for pacemaker-operation control, and in accordance with the invention, and withinblock 16, a computer calculation is thus performed to acquire an actual AC Value through a process of simple averaging of the several collected and calculated % LVST values drawn from each of the “collected” ten-cardiac-cycle streams of heart-behavior data. This calculated, actual AC Value is supplied to block 20 (labeled “Compare”) viacommunication connection 32. - In
block 20, a comparison takes place between the just-mentioned, calculated, actual AC Value and a reference AC Value which is furnished to block 20 viacommunication connection 34 fromblock 18, wherein an appropriate location in the memory of the mentioned computer has previously stored such a reference value. The definition of reference AC Value has been provided earlier herein, and for the purpose of ongoing description of the methodology of the invention, we will assume that this reference value has been based upon previously acquired, real-time heart-functionality data derived directly from the subject, per se, during a prior span of time when medical personnel have determined that the subject's heart is performing in normal and satisfactory pumping and filling manners. This reference AC Value takes the form of a calculated, appropriately simply averaged value drawn from the collection of % LVST values acquired during a plurality (which may be ten, or more) of cardiac cycles that occurred during such a normal heart-operating period of time. - From the comparison which is produced in
block 20, any difference which is detected between the actual AC Value, as calculated, and the stored, reference AC Value, is noted and supplied to block 22 viacommunication connection 36. - We will further assume, at this point in the description of the operation of the methodology of the present invention, that
block 22, which is, at least partially, a “question-asking” block labeled “Time for Off State?” is in a condition noting that it is not yet time to interrupt the currently active, sustained, pacemaker On State, and thus develops the answer “No” to this question. This “developed” answer effectively creates a through-block-22 connection to previously mentionedcommunication connection 38, which supplies any such compared AC-Value difference information coming fromblock 20 directly to block 24 (“Adjust Pacemaker Operation”). - At this point in the invention description, and staying for a moment with
block 22 before discussing the behavior ofblock 24, one should note the existence of a relevant, additional, arrow-headedcommunication connection 42 which appears fragmentarily inFIG. 2 , and which extends and points downwardly fromblock 22. More will be said in detail aboutconnection 42 shortly, but at this stage, it is sufficient to say thatconnection 42 represents that the answer to the “timing question” posed inblock 22 is “Yes”. As will soon be elaborated,connection 42 extends to the block-schematic arrangement pictured inFIG. 3 . - The AC-Value difference information which is passed by way of
connection 38 to block 24 causes block 24 to send, by way ofcommunication connection 40, to pacemaker 14 a control signal, or signals, which effect(s) an operational adjustment, or adjustments, as necessary, to re-form the pacing operation of the pacemaker so as to stimulateheart 12 in a manner intended to minimize the difference between a calculated, current, during-pacing-therapy, actual AC Value and the reference AC Value. This adjustment, of course, is aimed at furnishing therapy deemed most appropriate to improving the pumping and filling behaviors ofheart 12. The preferred adjustments take the form of specific adjustments made in one or more of the pacing rate, the pacing intensity, the AV delay, and the IV delay operational behavior(s) of the pacemaker. Throughout the sustained On-State operating time of the pacemaker, recurrent heart-functionality monitoring, and calculating of actual AC Values, take place, followed by respective comparison activities inblock 20, as explained, thereby to produce operational control adjustments as needed which are delivered byblock 24 to the pacemaker in a continual feedback effort to maintain, as closely as possible, an equality of actual and reference AC Values. The frequency of recurrent monitoring and of associated actual AC Value calculations is a matter of user choice, and is programmed appropriately into computer C. - What can thus be seen is that the arrangement pictured in
FIG. 2 takes the form of a pacemaker operational-adjustment (pacing rate, pacing intensity, AV delay, and IV delay) feedback loop forpacemaker 14. More particularly, it possesses the form of such a feedback loop which, on a user-selected time basis, is interruptible under the influence ofblock 22, as will now be explained. - Accordingly, turning attention to
FIG. 3 , whenblock 22 inFIG. 2 determines that the time (the end of the current, sustained (full-term) On-State operating condition for the pacemaker) has arrived to placepacemaker 14, at least temporarily, in an Off State, it breaks the previously existing operational-adjustment feedback loop pictured inFIG. 2 , and sends a “timing associated” signal overconnection 42 to aninput block 44 inFIG. 3 . Thus, with respect to the resulting state of the feedback loop pictured inFIG. 2 , and during the time period which is about to occur wherein the pacemaker will be switched, as just mentioned temporarily at least, into an Off State, no operational-control signaling is supplied overconnection 38 topacemaker 14. - Pictured in
FIG. 3 , in addition to just-mentionedblock 44, are seven additional blocks numbered 46, 48, 50, 52, 54, 56, 58. Associated with these blocks inFIG. 3 , and for the most part establishing communication/control connections between and or from these blocks, and illustrated by arrow-headed lines, areconnections FIG. 2 andFIG. 3 , that previously mentionedconnection 30 which, inFIG. 2 interconnects blocks 12, 16, also interconnectsblock 12 inFIG. 2 and block 46 inFIG. 3 . - When the just-above-mentioned “timing” signal arrives at
block 44 overconnection 42 fromblock 22, indicating that it is now time to placepacemaker 14 in an Off State, this action is performed byblock 44, which then sends a signal viaconnection 60 to block 46—a block which is essentially the same in structure and functionality (within computer C) as previously describedblock 16 shown inFIG. 2 . Accordingly, block 46, as was true withblock 16, receives overconnection 30, from a ten-cycle plurality of heart-cycles, heart-functionality ECG and heart-the sound information with respect to which it then calculates a current, Off-State actual AC Value. This Value is transmitted byconnection 62 to comparison block 50 which performs in the same manner described earlier forblock 20 seen inFIG. 2 . -
Block 48, “operating” from, and functioning as, memory within computer C, presents to block 50, viaconnection 64, the last-calculated, actual, On-State AC Value. In accordance with the operation ofblock 50, any difference which exists between these two compared AC Values is supplied viaconnection 66 to block 52 which is an inquiry block that asks the question about whether or not, based on the difference information (if any) now presented onconnection 66, the actual AC Value now appearing onconnection 62 is better than the last-calculated, actual AC Value presented byconnection 64 fromblock 48 to block 50. - If the answer to this question is “No”, block 52 supplies over
connection 68 to block 54 such an indication which then causes block 54 (a) to return (i.e., switch)pacemaker 14 to the On State, and (b) to send a signal viaconnection 70 to block 16 inFIG. 2 to resume operation as described earlier with regard to this figure. This “No” indication produced byblock 52 thereby effectively returns the pacemaker to the beginning of another, full-length, sustained On-State operating period, whereby all of the activity previously described as being carried on in the arrangement pictured inFIG. 2 resumes as before described. - If the answer to the question asked by
block 52 is “Yes”, then block 52 sends to block 56, by way ofconnection 72, a signal which effectively causespacemaker 14 to be held now in, and for, the full duration of the earlier-mentioned, predetermined, sustained Off-State time period. Placement of the pacemaker in this sustained Off State is noted overconnection 74 byinquiry block 58 inFIG. 3 , which block asks the question regarding whether it is yet time (i.e. at the end of the current Off State condition in the pacemaker) to return the pacemaker, at least temporarily, to the On State. So long as the intended, current, sustained Off-State period forpacemaker 14 is “under way”, block 58 generates a “No” answer which is supplied viacommunication connection 76 to block 56 in a manner which effectively causespacemaker 14 confirmedly to be held in the Off State. - When
block 58 determines that the end of the sustained Off State forpacemaker 14 has arrived, this block generates a “Yes” answer which is communicated, as will now shortly be described, by way ofcommunication connection 78 to ablock 80 which is included in the block/schematic arrangement pictured inFIG. 4 . - What can thus be seen with respect to the on/off staging and pacing operation which has just been described respecting the behavior of the arrangement shown in
FIG. 3 , following the activities described in relation toFIG. 2 , is that, after the conclusion of a sustained On-State period of operation for pacemaker 14 (FIG. 2 condition), a determination is made regarding the normalcy and acceptability of a subject's pumping and filling heart behaviors, thus to assess whether or not full-term pacing therapy should be resumed, or whether it is now time to switch the pacemaker into an Off State to allow the subject's heart to function without therapy assistance. This decision is based upon the comparison which is made inblock 50, and is very specifically based upon an assessment, through looking at comparative actual AC Values, whether to resume immediately pacemaker pacing support, or to allow the heart to continue to function without pacing support for the user-preselected nominal, sustained, full-term operating time for a pacemaker Off State. Where an Off State appears to be the appropriate methodology behavior at this point in time, a predetermined-length (full-term) Off State condition begins. When this period begins, and as will now be more fully described, the operation of the invention methodology is then placed under the control of what is pictured inFIG. 4 . - Focusing attention now on
FIG. 4 , included in this figure, in addition to previously briefly mentionedblock 80, are six additional blocks numbered 82, 84, 86, 88, 90, 92. Variously interconnecting, and extending from, the seven blocks seen inFIG. 4 arecommunication connections blocks connections - When a signal is sent via
connection 78 fromblock 58 inFIG. 3 to block 80 inFIG. 4 , this signal indicates that it is time, at least temporarily, to placepacemaker 14 in an On State. Accordingly, this signal causesblock 80 to turnpacemaker 14 back to an On-State condition wherein it furnishes therapy toheart 12. - Further, following receipt of the mentioned signal over
connection 78, block 80 communicates to block 82, viaconnection 94, that there should now take place the same monitoring and calculating activities which have previously been described as being performed inblocks blocks 16, 30), receives full “information-collection cycle” ECG and heart-sound information overconnection 30 fromheart 12, and calculates a new On-State actual AC Value which is then supplied viaconnection 96 tocomparison block 86. This newly calculated actual AC Value which is, now, at least temporarily, based upon pacemaker therapy being provided to the subject's heart, is compared inblock 86 with a computer stored value inblock 84 of the last-calculated Off-State actual AC Value, the latter being communicated viaconnection 98 to block 86. What is thus now occurring inblock 86 is a comparison to determine whether the last calculated actual AC Value acquired during the just-terminated Off State in the pacemaker is different from the newly calculated actual AC Value based upon switching back on of the pacemaker in accordance with the operation ofblock 80. Any difference in these two values noted through comparison inblock 86 is supplied byconnection 100 to question-posingblock 88 which asks the question whether the newly calculated actual AC Value in the On State of the pacemaker is better than the last-calculated Off-State AC Value stored inblock 84. - If the answer to this question is “Yes”, block 88 communicates this answer effectively via previously mentioned
communication connection 70 to block 16 inFIG. 2 to place the pacemaker effectively in the same operating condition, i.e., at the beginning of a full-term, sustained On-State mode of operation, as was initially described with respect to the operation of the methodology steps pictured inFIG. 2 . However, if the answer to the question posed byblock 88 is “No”, this condition is communicated viaconnection 102 to block 90 which, at this point in time, switches and returnspacemaker 14 to the Off State to begin another full-term, sustained Off-State operating period for the pacemaker. - This condition is now communicated by way of
communication connection 104 to block 92 which is a question-asking block, and which specifically asks the question whether it is yet time to conclude the sustained Off-State condition in the pacemaker, and return the pacemaker, at least temporarily, to the On-State condition. If the answer to this question is “No”, communication betweenblocks connection 106 functions to maintainpacemaker 14 in the Off State. If the answer to the question is “Yes”, then this condition is communicated viaconnection 78 to just previously discussedblock 80 appearing at the left side inFIG. 4 to begin a next “cycle” of operation in, and as described for,FIG. 4 . - What one can thus see about the operation of the methodology portion of the invention which is illustrated in
FIG. 4 is that a kind of feedback loop exists which possesses the tendency to maintain the pacemaker in an Off-State condition for as many of its pre-planned, full-term, sustained off-period intervals as possible—returning the pacemaker to an On-State condition only when comparison activity which takes place inblock 86 indicates that an actual AC Value associated with the Off State of the pacemaker is poorer than the last-noted On-State actual AC Value. - The present invention thus proposes a unique physiologic-on-demand, heart-pacing-device operation, wherein there is a very clear propensity to invoke minimal-time operation of such a device.
- Accordingly, one way of expressing the invention is to describe it as being a physiologic-demand method using acquired ECG and heart-sound information for operationally adjusting, and for controlling the on and off states of, an implanted or external heart-pacing therapy device associated with a subject having heart failure, this method including the steps of: (a) selecting at least one of the heart-functionality parameters % LVST, S3, S4 and EMAT to form a basis for a calculated, acoustic cardiographic therapy (AC) value which is to be employed in relation to the desired adjusting and controlling; (b) based on such selecting, establishing a desired, reference, AC value; (c) monitoring real-time, subject ECG and heart-sound information, and periodically calculating therefrom actual AC values; (d) utilizing various, different comparisons between the actual and reference AC values, and employing a selected feedback loop approach, controlling both the on-state/off-state status of the therapy device, and the on state, adjusted operational behavior of that device, in an overall manner aimed at both (1) maintaining a minimum difference between the actual and the reference AC values, and (2) maximizing off-state time in the therapy device; and (e), by such utilizing and controlling steps, effecting a heart-functionality-based, on-demand, therapy relationship between the subject's heart and the therapy device, wherein therapy-based heart-functionality control is minimized.
- The methodology of the invention may, in the context just expressed above, more specifically be described as one wherein the above-mentioned feedback loop approach includes implementing an interruptible, operational-adjustment feedback loop, and the controlling activity includes (a) on a selected time basis periodically interrupting that loop, (b) during each such interruption, and beginning therein with the therapy device in a controlled off-state, periodically checking actual AC values in both on and off states of the therapy device so as effectively and preferentially to maintain that device in an off state until an off-state actual AC value is found by comparison to be poorer in relation to the reference AC value than the actual AC value in the on state, and then returning the therapy device to the on state, and (c), thereafter returning to the implementing step, and recurrently repeating these just (in this paragraph) mentioned (a), (b) and (c) steps.
- If desired, the so far described practice of the invention may be modified by introducing information feedback, as suggested earlier herein, from
pacemaker 14 to computer C so as to effect relational changes in the manner in which the operational feed back loop shown inFIG. 2 functions. Preferred feedback information, in the context of the operation of theFIG. 2 loop, is designed (conventionally) to affect at least one of pacing rate, pacing intensity, AV delay, and IV delay. - Preferably, although not necessarily, all structure, firmware and software which are relevant to the practice of the invention, including a programmable digital computer with an appropriate memory, and all operational algorithmic software, are effectively “onboard” and installed as “component parts/aspects” of the heart-pacing device which is employed.
- Thus, an on-again, off-again, physiologic-demand, therapy-device-management methodology for heart pacing has been disclosed—a methodology possessing a key focus on minimizing the On-State time of an internal or external, heart-pacing therapy device. Accordingly, while a preferred and best-mode embodiment of, and manner of practicing, the invention have been illustrated and described herein, it is appreciated that further variations and modifications thereof may be made within the scope of the invention as defined in the appended claims.
Claims (6)
1. A physiologic-demand method using acquired ECG and heart-sound information for operationally adjusting, and for controlling the on and off states of, an implanted or external heart-pacing therapy device associated with a subject having heart failure, said method comprising
selecting at least one of the heart-functionality parameters % LVST, S3, S4 and EMAT to form a basis for a calculated, acoustic cardiographic therapy (AC) value which is to be employed in relation to said adjusting and controlling,
based on said selecting, establishing a desired, reference, AC value,
monitoring real-time, subject ECG and heart-sound information, and periodically calculating therefrom actual AC values,
utilizing various, different comparisons between the actual and reference AC values, and employing a selected feedback loop approach, controlling both (a) the on-state/off-state status of the therapy device, and (b) the on state, adjusted operational behavior of that device, in an overall manner aimed at both (1) maintaining a minimum difference between the actual and the reference AC values, and (2) maximizing off-state time in the therapy device, and
by said utilizing and controlling, effecting a heart-functionality-based, on-demand, therapy relationship between the subject's heart and the therapy device, wherein pacing-therapy-based heart-functionality control is minimized.
2. The method of claim 1 , wherein said selecting focuses particularly on the singular parameter % LVST.
3. The method of claim 1 , wherein said selecting focuses particularly on the two parameters S3 and EMAT.
4. The method of claim 1 , wherein said establishing is based upon subject-specific ECG and heart-sound information.
5. The method of claim 1 , wherein said establishing is based upon ECG and heart-sound information drawn from a selected-population database.
6. The method of claim 1 , wherein the mentioned feedback loop approach includes implementing an interruptible, operational-adjustment feedback loop, and said controlling includes
(a) on a selected time basis periodically interrupting that loop,
(b) during each such interruption, and beginning therein with the therapy device in a controlled off-state, periodically checking actual AC values in both on and off states of the therapy device so as effectively and preferentially to maintain that device in an off state until an off-state actual AC value is found by comparison to be poorer in relation to the reference AC value than the actual AC value in the on state, and then returning the therapy device to the on state, and
(c) thereafter returning to the implementing step, and recurrently repeating the (a), (b) and (c) steps.
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Cited By (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20100069768A1 (en) * | 2008-09-16 | 2010-03-18 | Pacesetter, Inc. | Use of cardiohemic vibration for pacing therapies |
US9095718B2 (en) | 2012-04-04 | 2015-08-04 | Medtronic, Inc. | Heart-sounds based adaptive cardiac resynchronization therapy timing parameter optimization system |
US9498625B2 (en) | 2012-12-19 | 2016-11-22 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US20180192894A1 (en) * | 2006-12-27 | 2018-07-12 | Cardiac Pacemakers, Inc. | Risk stratification based heart failure detection algorithm |
US10335592B2 (en) | 2012-12-19 | 2019-07-02 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
US10369361B2 (en) | 2016-04-29 | 2019-08-06 | Viscardia, Inc. | Leads for implantable medical device that affects pressures within the intrathoracic cavity through diaphragmatic stimulation |
US20220265219A1 (en) * | 2012-12-26 | 2022-08-25 | Cardiac Pacemakers, Inc. | Neural network based worsening heart failure detection |
US11458312B2 (en) | 2019-09-26 | 2022-10-04 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11615891B2 (en) | 2017-04-29 | 2023-03-28 | Cardiac Pacemakers, Inc. | Heart failure event rate assessment |
US11957914B2 (en) | 2020-03-27 | 2024-04-16 | Viscardia, Inc. | Implantable medical systems, devices and methods for delivering asymptomatic diaphragmatic stimulation |
Families Citing this family (10)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JP5343130B2 (en) * | 2008-08-01 | 2013-11-13 | カーディアック ペースメイカーズ, インコーポレイテッド | System for detection of myocardial ischemia during exertion |
WO2011025415A1 (en) * | 2009-08-27 | 2011-03-03 | St. Jude Medical Ab | Devices and method for determining and monitoring a cardiac status of a patient by using plvdt or plvst parameters |
EP3013410A4 (en) | 2013-06-26 | 2017-03-15 | Zoll Medical Corporation | Therapeutic device including acoustic sensor |
WO2016100906A1 (en) | 2014-12-18 | 2016-06-23 | Zoll Medical Corporation | Pacing device with acoustic sensor |
WO2016149583A1 (en) | 2015-03-18 | 2016-09-22 | Zoll Medical Corporation | Medical device with acoustic sensor |
US10327648B2 (en) | 2015-04-01 | 2019-06-25 | Siemens Healthcare Gmbh | Blood vessel mechanical signal analysis |
US11617538B2 (en) | 2016-03-14 | 2023-04-04 | Zoll Medical Corporation | Proximity based processing systems and methods |
US11207527B2 (en) | 2016-07-06 | 2021-12-28 | Cardiac Pacemakers, Inc. | Method and system for determining an atrial contraction timing fiducial in a leadless cardiac pacemaker system |
US11284827B2 (en) | 2017-10-21 | 2022-03-29 | Ausculsciences, Inc. | Medical decision support system |
US10932726B2 (en) | 2018-03-16 | 2021-03-02 | Zoll Medical Corporation | Monitoring physiological status based on bio-vibrational and radio frequency data analysis |
Citations (12)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5392780A (en) * | 1991-12-19 | 1995-02-28 | Nihon Kogden Corporation | Apparatus for measuring biological signal |
US20040127792A1 (en) * | 2002-12-30 | 2004-07-01 | Siejko Krzysztof Z. | Method and apparatus for monitoring of diastolic hemodynamics |
US20050027323A1 (en) * | 2001-10-30 | 2005-02-03 | Medtronic, Inc. | Implantable medical device for monitoring cardiac blood pressure and chamber dimension |
US7039538B2 (en) * | 2004-03-08 | 2006-05-02 | Nellcor Puritant Bennett Incorporated | Pulse oximeter with separate ensemble averaging for oxygen saturation and heart rate |
US20060155202A1 (en) * | 2005-01-12 | 2006-07-13 | Arand Patricia A | Hemodynamic assessment/adjustment |
US7174203B2 (en) * | 2004-11-18 | 2007-02-06 | Inovise Medical, Inc. | Method and system relating to monitoring and characterizing heart condition |
US20070038137A1 (en) * | 2005-05-26 | 2007-02-15 | Inovise Medical, Inc. | Cardio-function cafeteria system and methodology |
US7225021B1 (en) * | 2004-01-30 | 2007-05-29 | Pacesetter, Inc. | Differentiation of central sleep apnea and obstructive sleep apnea using an implantable cardiac device |
US20080021510A1 (en) * | 2006-07-21 | 2008-01-24 | Cardiac Pacemakers, Inc. | Resonant structures for implantable devices |
US20080177191A1 (en) * | 2007-01-19 | 2008-07-24 | Cardiac Pacemakers, Inc. | Ischemia detection using heart sound timing |
US20090165559A1 (en) * | 2004-11-23 | 2009-07-02 | Drexel University | Method and apparatus for interfacial sensing |
US7559903B2 (en) * | 2007-03-28 | 2009-07-14 | Tr Technologies Inc. | Breathing sound analysis for detection of sleep apnea/popnea events |
Family Cites Families (25)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4589420A (en) | 1984-07-13 | 1986-05-20 | Spacelabs Inc. | Method and apparatus for ECG rhythm analysis |
US5758654A (en) * | 1996-08-29 | 1998-06-02 | Harley Street Software Ltd. | ECG P QRS T onset and peak detection method |
US7171269B1 (en) * | 1999-05-01 | 2007-01-30 | Cardiodigital Limited | Method of analysis of medical signals |
GB0014855D0 (en) * | 2000-06-16 | 2000-08-09 | Isis Innovation | Combining measurements from different sensors |
US6580946B2 (en) * | 2001-04-26 | 2003-06-17 | Medtronic, Inc. | Pressure-modulated rate-responsive cardiac pacing |
US7113820B2 (en) * | 2001-07-12 | 2006-09-26 | The United States Of America As Represented By The Administration Of The National Aeronautics And Space Administration | Real-time, high frequency QRS electrocardiograph |
US7819814B2 (en) * | 2002-10-21 | 2010-10-26 | Noam Gavriely | Acoustic assessment of the heart |
US20050080348A1 (en) * | 2003-09-18 | 2005-04-14 | Stahmann Jeffrey E. | Medical event logbook system and method |
IL155955A0 (en) * | 2003-05-15 | 2003-12-23 | Widemed Ltd | Adaptive prediction of changes of physiological/pathological states using processing of biomedical signal |
US7074195B2 (en) * | 2003-06-13 | 2006-07-11 | Inovise Medical, Inc. | Real-time, sound-quality-competitive, single-site from plural-site, anatomical audio signal selection |
US7096060B2 (en) * | 2003-06-27 | 2006-08-22 | Innovise Medical, Inc. | Method and system for detection of heart sounds |
US7302290B2 (en) * | 2003-08-06 | 2007-11-27 | Inovise, Medical, Inc. | Heart-activity monitoring with multi-axial audio detection |
WO2005028558A1 (en) * | 2003-09-22 | 2005-03-31 | Matsushita Electric Industrial Co., Ltd. | Flame-retardant resin composition, process for producing the same, and method of molding the same |
WO2005056671A1 (en) * | 2003-12-10 | 2005-06-23 | Teijin Chemicals Ltd. | Flame-retardant styrene resin composition and molded article obtained therefrom |
US7431699B2 (en) | 2003-12-24 | 2008-10-07 | Cardiac Pacemakers, Inc. | Method and apparatus for third heart sound detection |
US20050222515A1 (en) * | 2004-02-23 | 2005-10-06 | Biosignetics Corporation | Cardiovascular sound signature: method, process and format |
JP4495557B2 (en) * | 2004-09-17 | 2010-07-07 | 富士通マイクロエレクトロニクス株式会社 | Semiconductor integrated circuit layout apparatus, semiconductor integrated circuit layout program, and semiconductor integrated circuit layout system |
US7435221B1 (en) * | 2004-11-24 | 2008-10-14 | Pacesetter, Inc. | System and method for detecting abnormal respiration based on intracardiac electrogram signals using a pattern recognition device |
US20070055151A1 (en) * | 2005-01-20 | 2007-03-08 | Shertukde Hemchandra M | Apparatus and methods for acoustic diagnosis |
US7424321B2 (en) * | 2005-05-24 | 2008-09-09 | Cardiac Pacemakers, Inc. | Systems and methods for multi-axis cardiac vibration measurements |
US8152731B2 (en) * | 2006-02-10 | 2012-04-10 | Inovise Medical, Inc. | Wavelet transform and pattern recognition method for heart sound analysis |
US20080255465A1 (en) * | 2007-04-16 | 2008-10-16 | Inovise Medical, Inc. | Heart-function information display including color-range scalogram content |
US9986926B2 (en) | 2007-10-26 | 2018-06-05 | Inovise Medical, Inc. | Q-onset ventricular depolarization detection in the presence of a pacemaker |
US8137283B2 (en) * | 2008-08-22 | 2012-03-20 | International Business Machines Corporation | Method and apparatus for retrieval of similar heart sounds from a database |
US8577448B2 (en) * | 2008-10-14 | 2013-11-05 | Inovise Medical, Inc. | Differential apneic detection in aid of diagnosis and treatment |
-
2009
- 2009-01-23 US US12/321,646 patent/US8185190B2/en active Active
- 2009-01-23 US US12/321,647 patent/US8412323B2/en active Active
- 2009-01-23 US US12/321,650 patent/US20090192561A1/en not_active Abandoned
Patent Citations (12)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US5392780A (en) * | 1991-12-19 | 1995-02-28 | Nihon Kogden Corporation | Apparatus for measuring biological signal |
US20050027323A1 (en) * | 2001-10-30 | 2005-02-03 | Medtronic, Inc. | Implantable medical device for monitoring cardiac blood pressure and chamber dimension |
US20040127792A1 (en) * | 2002-12-30 | 2004-07-01 | Siejko Krzysztof Z. | Method and apparatus for monitoring of diastolic hemodynamics |
US7225021B1 (en) * | 2004-01-30 | 2007-05-29 | Pacesetter, Inc. | Differentiation of central sleep apnea and obstructive sleep apnea using an implantable cardiac device |
US7039538B2 (en) * | 2004-03-08 | 2006-05-02 | Nellcor Puritant Bennett Incorporated | Pulse oximeter with separate ensemble averaging for oxygen saturation and heart rate |
US7174203B2 (en) * | 2004-11-18 | 2007-02-06 | Inovise Medical, Inc. | Method and system relating to monitoring and characterizing heart condition |
US20090165559A1 (en) * | 2004-11-23 | 2009-07-02 | Drexel University | Method and apparatus for interfacial sensing |
US20060155202A1 (en) * | 2005-01-12 | 2006-07-13 | Arand Patricia A | Hemodynamic assessment/adjustment |
US20070038137A1 (en) * | 2005-05-26 | 2007-02-15 | Inovise Medical, Inc. | Cardio-function cafeteria system and methodology |
US20080021510A1 (en) * | 2006-07-21 | 2008-01-24 | Cardiac Pacemakers, Inc. | Resonant structures for implantable devices |
US20080177191A1 (en) * | 2007-01-19 | 2008-07-24 | Cardiac Pacemakers, Inc. | Ischemia detection using heart sound timing |
US7559903B2 (en) * | 2007-03-28 | 2009-07-14 | Tr Technologies Inc. | Breathing sound analysis for detection of sleep apnea/popnea events |
Cited By (24)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20180192894A1 (en) * | 2006-12-27 | 2018-07-12 | Cardiac Pacemakers, Inc. | Risk stratification based heart failure detection algorithm |
US9717914B2 (en) * | 2008-09-16 | 2017-08-01 | Pacesetter, Inc. | Use of cardiohemic vibration for pacing therapies |
US20100069768A1 (en) * | 2008-09-16 | 2010-03-18 | Pacesetter, Inc. | Use of cardiohemic vibration for pacing therapies |
US9095718B2 (en) | 2012-04-04 | 2015-08-04 | Medtronic, Inc. | Heart-sounds based adaptive cardiac resynchronization therapy timing parameter optimization system |
US11020596B2 (en) | 2012-12-19 | 2021-06-01 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US9694185B2 (en) | 2012-12-19 | 2017-07-04 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US10315035B2 (en) | 2012-12-19 | 2019-06-11 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US10335592B2 (en) | 2012-12-19 | 2019-07-02 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
US9968786B2 (en) | 2012-12-19 | 2018-05-15 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US11684783B2 (en) | 2012-12-19 | 2023-06-27 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US11666757B2 (en) | 2012-12-19 | 2023-06-06 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
US9498625B2 (en) | 2012-12-19 | 2016-11-22 | Viscardia, Inc. | Hemodynamic performance enhancement through asymptomatic diaphragm stimulation |
US11147968B2 (en) | 2012-12-19 | 2021-10-19 | Viscardia, Inc. | Systems, devices, and methods for improving hemodynamic performance through asymptomatic diaphragm stimulation |
US20220265219A1 (en) * | 2012-12-26 | 2022-08-25 | Cardiac Pacemakers, Inc. | Neural network based worsening heart failure detection |
US10369361B2 (en) | 2016-04-29 | 2019-08-06 | Viscardia, Inc. | Leads for implantable medical device that affects pressures within the intrathoracic cavity through diaphragmatic stimulation |
US11400286B2 (en) | 2016-04-29 | 2022-08-02 | Viscardia, Inc. | Implantable medical devices, systems, and methods for selection of optimal diaphragmatic stimulation parameters to affect pressures within the intrathoracic cavity |
US10537735B2 (en) | 2016-04-29 | 2020-01-21 | Viscardia, Inc. | Implantable medical devices and methods for real-time or near real-time adjustment of diaphragmatic stimulation parameters to affect pressures within the intrathoracic cavity |
US10493271B2 (en) | 2016-04-29 | 2019-12-03 | Viscardia, Inc. | Implantable medical devices, systems, and methods for selection of optimal diaphragmatic stimulation parameters to affect pressures within the intrathoracic cavity |
US11615891B2 (en) | 2017-04-29 | 2023-03-28 | Cardiac Pacemakers, Inc. | Heart failure event rate assessment |
US11458312B2 (en) | 2019-09-26 | 2022-10-04 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11524158B2 (en) | 2019-09-26 | 2022-12-13 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11911616B2 (en) | 2019-09-26 | 2024-02-27 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11925803B2 (en) | 2019-09-26 | 2024-03-12 | Viscardia, Inc. | Implantable medical systems, devices, and methods for affecting cardiac function through diaphragm stimulation, and for monitoring diaphragmatic health |
US11957914B2 (en) | 2020-03-27 | 2024-04-16 | Viscardia, Inc. | Implantable medical systems, devices and methods for delivering asymptomatic diaphragmatic stimulation |
Also Published As
Publication number | Publication date |
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US20090204167A1 (en) | 2009-08-13 |
US8412323B2 (en) | 2013-04-02 |
US8185190B2 (en) | 2012-05-22 |
US20090204165A1 (en) | 2009-08-13 |
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