# US 11,305,124 B2 · System and method for pacing parameter optimization using heart sounds

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- Number: US 11,305,124 B2
- Document ID: US11305124B2
- Status: Granted
- Kind: B2
- Application number: 16/551,412
- Filed: 2019-08-26
- Published: 2019-12-19
- Granted: 2022-04-19
- Earliest claimed: 2011-07-29
- Assignees: Medtronic, Inc.
- Applicants: Medtronic, Inc.
- Inventors: Xusheng Zhang; Jeffrey M. Gillberg; Thomas J. Mullen
- Web page: https://patentgrep.com/patent/US11305124B2

## CPC

- A61N 1/3627: {for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy}
- A61B 7/00: Instruments for auscultation
- A61B 7/04: Electric stethoscopes
- A61N 1/36578: {controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone}
- A61N 1/3682: {with a variable atrioventricular delay}
- A61N 1/36842: {Multi-site stimulation in the same chamber}
- A61N 1/3686: {configured for selecting the electrode configuration on a lead (A61N1/3688 takes precedence)}
- A61N 1/3702: {Physiological parameters (A61N1/365 takes precedence; evoked response A61N1/371)}
- A61N 1/37247: {User interfaces, e.g. input or presentation means}
- A61N 1/37264: {Changing the program; Upgrading firmware}
- A61N 1/3684: {for stimulating the heart at multiple sites of the ventricle or the atrium}
- A61N 1/36843: {Bi-ventricular stimulation}
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

A medical device system and associated method predict a patient response to a cardiac therapy. The system includes for delivering cardiac pacing pulses to a patient's heart coupled to a cardiac sensing module and a cardiac pacing module for generating cardiac pacing pulses and controlling delivery of the pacing pulses at multiple pace parameter settings. An acoustical sensor obtains heart sound signals. A processor is enabled to receive the heart sound signals, derive a plurality of heart sound signal parameters from the heart sound signals, and determine a trend of each of the plurality of heart sound signal parameters with respect to the plurality of pace parameter settings. An external display is configured to present the trend of at least one heart sound parameter with respect to the plurality of pace parameter settings.

## Claims

### Claim 1

A method comprising:
delivering, by a medical device system, pacing pulses at varying pacing settings;
obtaining, by the medical device system, heart sound signals from an acoustical sensor;
determining, by the medical device system and based on the heart sound signals, a plurality of heart sound signal parameters;
determining, by the medical device system and based on the heart sound signal parameters, a relative change of a V-S2 interval, wherein the V-S2 interval is a time interval between a ventricular electrical event and an S2 heart sound, and wherein the relative change of the V-S2 interval is responsive to the varying pacing settings;
identifying, by the medical device system and based on the relative change of the V-S2 interval, a target pacing parameter;
delivering, by the medical device system, pacing pulses according to the target pacing parameter;
deriving, by the medical device system, a trend of the V-S2 intervals with respect to the varying pacing settings; and
displaying, by the medical device system, the trend of the V-S2 intervals with respect to the varying pacing settings.

### Claim 2 (depends on 1)

The method of claim 1 wherein the varying pacing settings comprises a plurality of pacing vectors.

### Claim 3 (depends on 2)

The method of claim 2 wherein the plurality of pacing vectors are selected from a plurality of electrodes positioned along a chamber of a heart.

### Claim 4 (depends on 2)

The method of claim 2 wherein an optimal pacing vector is selected from the plurality of pacing vectors.

### Claim 5 (depends on 1)

The method of claim 1 wherein the varying pacing settings comprises a plurality of pacing sites along a chamber of a heart.

### Claim 6 (depends on 5)

The method of claim 5 wherein the chamber of the heart comprises a left ventricle.

### Claim 7 (depends on 5)

The method of claim 5 wherein the plurality of electrodes are positioned along a distal end of a multi-polar lead.

### Claim 8 (depends on 7)

The method of claim 7 wherein a proximal end of the multi-polar lead is coupled to the implantable medical device system.

### Claim 9 (depends on 5)

The method of claim 5 wherein an optimal pacing site is selected from the plurality of pacing sites.

### Claim 10 (depends on 1)

The method of claim 1 the implantable medical device system comprising an implantable pacemaker, cardioverter, or defibrillator.

### Claim 11 (depends on 1)

The method of claim 1 further comprising:
responsive to obtaining heart sound signals, recording, by the medical device system, heart sound signals for varying pacing settings.

### Claim 12 (depends on 1)

The method of claim 1 wherein the varying pacing settings comprises one of interventricular (VV) interval settings, and atrial-ventricular (AV) interval settings.

### Claim 13

A medical device system comprising:
therapy delivery circuitry;
an acoustical sensor; and
processing circuitry, coupled to an external display, the processing circuitry configured to:
control delivery of pacing pulses by the therapy delivery circuitry at varying pacing settings, obtain heart sound signals from the acoustical sensor, determine, based on the heart sound signals, a plurality of heart sound signal parameters, determine, based on the heart sound signal parameters, a relative change of a V-S2 interval, wherein the V-S2 interval is a time interval between a ventricular electrical event and an S2 heart sound, and wherein the relative change of the V-S2 interval is responsive to the varying pacing settings, identify, based on the relative change of the V-S2 interval, a target pacing parameter, control delivery of pacing pulses at the target pacing parameter, and derive a trend of the V-S2 interval with respect to the varying pacing settings, wherein the external display configured to present a trend of the V-S2 interval with respect to pacing settings.

### Claim 14 (depends on 13)

The medical device system of claim 13 wherein the varying pacing settings comprises a plurality of pacing vectors.

### Claim 15 (depends on 14)

The medical device system of claim 14 wherein the plurality of pacing vectors are selected from a plurality of electrodes positioned along a chamber of a heart.

### Claim 16 (depends on 15)

The medical device system of claim 15 wherein the plurality of electrodes are positioned along a distal end of a multi-polar lead.

### Claim 17 (depends on 16)

The medical device system of claim 16 wherein a proximal end of the multi-polar lead is coupled to the implantable medical device system.

### Claim 18 (depends on 14)

The medical device system of claim 14 wherein an optimal pacing vector is selected from the plurality of pacing vectors.

### Claim 19 (depends on 13)

The medical device system of claim 13 wherein the varying pacing settings comprises a plurality of pacing sites along a chamber of a heart.

### Claim 20 (depends on 19)

The medical device system of claim 19 wherein the chamber of the heart comprises a left ventricle.

### Claim 21 (depends on 19)

The medical device system of claim 19 wherein an optimal pacing site is selected from the plurality of pacing sites.

### Claim 22 (depends on 13)

The medical device system of claim 13 comprising an implantable pacemaker, cardioverter, or defibrillator comprising the therapy delivery circuitry.

### Claim 23 (depends on 13)

The medical device system of claim 13 wherein the processing circuitry is configured to:
responsive to obtaining heart sound signals, record heart sound signals for varying pacing settings.

### Claim 24 (depends on 13)

The medical device system of claim 13 wherein the varying pacing settings comprises one of interventricular (VV) interval settings, and atrial-ventricular (AV) interval settings.

### Claim 25

A method comprising:
delivering, by a medical device system, pacing pulses at varying pacing settings;
obtaining, by the medical device system, electrical signals indicative of ventricular events and heart sound signals from an acoustical sensor;
determining, by the medical device system based on the electrical signals and the heart sound signals, a relative change of V-S2 intervals, wherein the V-S2 intervals are time intervals between the ventricular events and subsequent S2 heart sounds, and wherein the relative change of the V-S2 intervals is responsive to the varying pacing settings;
identifying, by the medical device system and based on the relative change of the V-S2 intervals, a target pacing parameter;
delivering, by the medical device system, pacing pulses according to the target pacing parameter;
deriving, by the medical device system, a trend of the V-S2 intervals with respect to the varying pacing settings; and
displaying, by the medical device system, the derived trend.

### Claim 26

A method comprising:
delivering, by a medical device system, pacing pulses at varying pacing settings;
obtaining, by the medical device system, electrical signals indicative of ventricular events and heart sound signals from an acoustical sensor;
determining, by the medical device system based on the heart sound signals, a plurality of heart sound signal parameters;
determining, by the medical device system based on the electrical signals and the heart sound signals, a relative change of V-S2 intervals, wherein the V-S2 intervals are time intervals between the ventricular electrical events and subsequent S2 heart sounds, and wherein the relative change of the V-S2 intervals is responsive to the varying pacing settings;
identifying, by the medical device system and based on the relative change of the V-S2 intervals, a target pacing parameter;
delivering, by the medical device system, pacing pulses according to the target pacing parameter;
deriving, by the medical device system, a trend of at least one of the heart sound signal parameters with respect to the varying pacing settings; and
displaying, by the medical device system, the derived trend.