WO2004078257B1 - Method and appartus for optimizing cardiac resynchronization therapy based on left ventricular acceleration - Google Patents

Method and appartus for optimizing cardiac resynchronization therapy based on left ventricular acceleration

Info

Publication number
WO2004078257B1
WO2004078257B1 PCT/US2004/004902 US2004004902W WO2004078257B1 WO 2004078257 B1 WO2004078257 B1 WO 2004078257B1 US 2004004902 W US2004004902 W US 2004004902W WO 2004078257 B1 WO2004078257 B1 WO 2004078257B1
Authority
WO
WIPO (PCT)
Prior art keywords
transducer
interventricular
computer readable
readable medium
lateral wall
Prior art date
Application number
PCT/US2004/004902
Other languages
French (fr)
Other versions
WO2004078257A1 (en
Inventor
Edward Chinchoy
Original Assignee
Medtronic Inc
Edward Chinchoy
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Medtronic Inc, Edward Chinchoy filed Critical Medtronic Inc
Priority to AU2004218488A priority Critical patent/AU2004218488A1/en
Priority to EP04712895A priority patent/EP1599257B1/en
Priority to JP2006508768A priority patent/JP4406720B2/en
Priority to DE602004016122T priority patent/DE602004016122D1/en
Priority to CA002517173A priority patent/CA2517173A1/en
Publication of WO2004078257A1 publication Critical patent/WO2004078257A1/en
Publication of WO2004078257B1 publication Critical patent/WO2004078257B1/en

Links

Classifications

    • 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
    • A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
    • 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
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
    • A61N1/36843—Bi-ventricular stimulation
    • 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
    • A61N1/36542—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 body motion, e.g. acceleration
    • 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
    • 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
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium

Abstract

A system and method for monitoring left ventricular cardiac contractility and for optimizing a cardiac therapy based on left ventricular lateral wall acceleration (LVA) are provided. The system includes an implantable or external cardiac stimulation device in association with a set of leads including a left ventricular epicardial or coronary sinus lead equipped with an acceleration sensor. The device receives and processes acceleration sensor signals to determine a signal characteristic indicative of LVA during isovolumic contraction. A therapy optimization method evaluates the LVA during varying therapy settings and selects the setting(s) that correspond to a maximum LVA during isovolumic contraction. In one embodiment, the optimal inter-ventricular pacing interval for use in cardiac resynchronization therapy is determined as the interval corresponding to the highest amplitude of the first LVA peak during isovolumic contraction.

Claims

32AMENDED CLAIMS[Received by the International Bureau on 23 September 2004 ( 23.09.04): original claims 1-35 replaced by amended claims 1-35]CLAIMS
1 , A method for assessing left ventricular function and optimizing cardiac pacing intervals in a device programmed to operate a bi-ventricular cardiac pacing modality, characterized by: disposing a transducer that is adapted to directly sense movement of a portion of a left ventricular chamber of a heart and providing a signal related to the movement; coupling said signal to a means for detecting the movement; iterativeϊy adjusting an interventricular (V-V) timing parameter of a first pacing electrode in electrical communication with one ventricle relative to a second pacing electrode in electrical communication with the other ventricle over a range of temporal values; for each of at least two of the interventricular (V-V) timing parameters, storing the interventricular (V-V) timing parameter and the peak amplitude value corresponding to a first peak of the signal obtained during an isovolumetric contraction portion of a cardiac cycle; comparing the magnitude of the stored peak amplitude values; and programming an optimized interventricular (V-V) interval using the interventricular (V-V) timing parameter corresponding to the highest stored peak amplitude value.
2, A method according to claim 1 , wherein said transducer is adapted to be disposed in a portion of the coronary sinus vessel or a blood vessel fluidly coupled to said coronary sinus.
3, A method according to claim 2, wherein said transducer includes an accelerometer. 33
4. A method according to claim 3, wherein the accelerometer comprises a uniaxiai accelerometer having a longitudinal sensing axis substantially aligned toward the left ventricular apex portion of the heart.
5. A method according to claim 2, wherein said transducer comprises a biaxial accelerometer,
6. A method according to claim 2, wherein said transducer comprises a triaxial accelerometer,
7. A method according to claim 1 , wherein said transducer is adapted to be disposed adjacent to a portion of the epicardium of the left ventricle of the heart.
8. A method according to claim 7, wherein the portion of the epicardium is a portion of the lateral wall of the left ventricle.
9. A method according to claim 8, wherein the portion of the lateral wall is a basal portion of the lateral wall.
10. A method according to claim 9, wherein the portion of the lateral wall is a mid-basal portion of the lateral wall.
11. A method according to claim 1 , wherein said transducer is adapted to be disposed within the pericardium of the heart.
12. A method according to claim 3, wherein the device comprises an implantable medical device.
13. A method according to claim 12, wherein the first pacing electrode or the second pacing electrode further comprises a sense electrode in electrical communication with a sensing circuit coupled to the device.
14, A computer readable medium programmed with instructions for performing a method for assessing left ventricular function and optimizing cardiac pacing intervals in a device programmed to operate a bi-ventricular cardiac pacing modality, characterized by: instructions for sensing movement of a portion of a left ventricular chamber of a heart with a deployed movement transducer and for measuring a signal from the transducer related to the movement; instructions for iteratively adjusting an interventricular (V-V) timing parameter of a first pacing electrode in electrical communication with one ventricle relative to a second pacing electrode in electrical communication with the other ventricle over a range of temporal values; instructions for storing at least two of the interventricular (V-V) timing parameters and, for each of at least two of the interventricular (V-V) timing parameters, instructions for relating each stored interventricular (V-V) timing parameters to a peak amplitude value corresponding to a first peak of the signal obtained during an isovolumetric contraction portion of a cardiac cycle; instructions for comparing the magnitude of the stored peak amplitude values; and instruction for programming an optimized interventricular (V-V) interval using the interventricular (V-V) timing parameter corresponding to the highest stored peak amplitude value.
15, A computer readable medium according to claim 14, wherein said transducer is adapted to be disposed in a portion of the coronary sinus vessel or a blood vessel fluidly coupled to said coronary sinus.
16, A computer readable medium according to claim 15, wherein said transducer comprises an accelerometer. 35
17. A computer readable medium according to claim 16, wherein the accelerometer comprises a uniaxial accelerometer having a longitudinal sensing axis substantially aligned toward the left ventricular apex portion of the heart,
18. A computer readable medium according to claim 15, wherein said transducer comprises a biaxial accelerometer.
19. A computer readable medium according to claim 15, wherein said transducer comprises a triaxial accelerometer,
20. A computer readable medium according to claim 14, wherein said transducer is adapted to be disposed adjacent to a portion of the epicardium of the left ventricle of the heart.
21. A computer readable medium according to claim 20, wherein the portion of the epicardium is a portion of the lateral wall of the left ventricle.
22. A computer readable medium according to claim 21 , wherein the portion of the lateral wall is a basal portion of the lateral wall.
23. A computer readable medium according to claim 22, wherein the portion of the lateral wall is a mid-basal portion of the lateral wall.
24. A computer readable medium according to claim 1 , wherein said transducer is adapted to be disposed within the pericardium of the heart.
25. A computer readable medium according to claim 16, wherein the device comprises an implantable medical device.
26. A computer readable medium according to claim 25, wherein the first pacing electrode or the second pacing electrode further comprises a sense 36 electrode in electrical communication with a sensing circuit coupled to the device and further comprising: instructions for measuring depolarization wave activity and at least temporarily storing at least one parameter related to the measured depolarization wave activity.
27. A computer readable medium according to claim 26, further comprising a variable voltage defibrillation circuit coupled to the device and in electrical communication with at least one high voltage electrode disposed adjacent the heart.
28. An apparatus for optimizing interventricular (V-V) synchrony and as a result of such optimization delivering closed-loop cardiac resynchronization therapy, characterized by: a transducer means for measuring movement of a portion of the lateral wall of a left ventricle and providing a movement signal related to such movement and coupled to a movement measurement circuit that is coupled to a pulse generator; a left pacing electrode in electrical communication with a portion of the left ventricle and electrically coupled to a pacing circuit of the pulse generator; a right pacing electrode in electrical communication with a portion of a right venticle and electrically coupled to the pacing circuit of the pulse generator; and interventricular (V-V) interval optimization means for iteratively changing a interventricular (V-V) interval for at least one cardiac cycle and storing a peak amplitude value corresponding to a first peak of the movement signal obtained during an isovolumetric contraction portion of a cardiac cycle in relation to the interventricular (V-V) interval used during the cardiac cycle, and for comparing the stored peak amplitudes and then programming an optimized interventricular (V-V) interval based on the inien entricular (V-V) interval corresponding to the greatest peak amplitude, 37
29. An apparatus according to claim 28, wherein the pulse generator is an implantable pulse generator.
30. An apparatus according to claim 28, wherein the pulse generator further comprises at least one defibrillatio'n electrode in electrical communication with at least one chamber of a heart and high-voltage circuitry disposed within the pulse generator.
31. An apparatus according to claim 28, wherein the transducer means further comprises an accelerometer and said left pacing electrode is coupled to said accelerometer.
32. An apparatus according to claim 28, wherein the transducer means comprises an accelerometer.
33. An apparatus according to claim 28, wherein the portion of the lateral wall is a mid-basal portion of the lateral wall.
34. An apparatus according to claim 33, wherein the portion of the left ventricle is a one of; an epicardial portion, an endocardial portion or a pericardia! portion.
35. An apparatus according to claim 33, further comprising a pacing electrode in electrical communication with an atrial chamber and electrically coupled to the pacing circuit of the pulse generator.
PCT/US2004/004902 2003-02-28 2004-02-19 Method and appartus for optimizing cardiac resynchronization therapy based on left ventricular acceleration WO2004078257A1 (en)

Priority Applications (5)

Application Number Priority Date Filing Date Title
AU2004218488A AU2004218488A1 (en) 2003-02-28 2004-02-19 Method and appartus for optimizing cardiac resynchronization therapy based on left ventricular acceleration
EP04712895A EP1599257B1 (en) 2003-02-28 2004-02-19 Apparatus for optimizing cardiac resynchronization therapy based on left ventricular acceleration
JP2006508768A JP4406720B2 (en) 2003-02-28 2004-02-19 Method and apparatus for optimizing cardiac resynchronization therapy based on left ventricular acceleration
DE602004016122T DE602004016122D1 (en) 2003-02-28 2004-02-19 APPARATUS FOR OPTIMIZING CARDIAL RESYNCHRONIZATION THERAPY BASED ON LEFT-RIDING ACCELERATION
CA002517173A CA2517173A1 (en) 2003-02-28 2004-02-19 Method and appartus for optimizing cardiac resynchronization therapy based on left ventricular acceleration

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US10/377,207 2003-02-28
US10/377,207 US6885889B2 (en) 2003-02-28 2003-02-28 Method and apparatus for optimizing cardiac resynchronization therapy based on left ventricular acceleration

Publications (2)

Publication Number Publication Date
WO2004078257A1 WO2004078257A1 (en) 2004-09-16
WO2004078257B1 true WO2004078257B1 (en) 2004-11-04

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Country Status (7)

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US (1) US6885889B2 (en)
EP (1) EP1599257B1 (en)
JP (1) JP4406720B2 (en)
AU (1) AU2004218488A1 (en)
CA (1) CA2517173A1 (en)
DE (1) DE602004016122D1 (en)
WO (1) WO2004078257A1 (en)

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