Cardiac resynchronization therapy optimization

A system for determining cardiac resynchronization therapy, CRT, settings for an implantable medical device, the system comprising:

• a first cardiac lead implantable in or in connection with a first chamber of a heart of a subject and having at least one pacing and sensing electrode,
• a second cardiac lead implantable in or in connection with a second chamber of said heart and having at least one pacing and sensing electrode,
• a hemodynamic sensor configured to generate output signals representative of a hemodynamic status of said subject;
• at least one pacing pulse generator coupled to said first and second cardiac leads and sensor and configured to generate pacing pulses;
• and
• a controller coupled to said at least one pacing pulse generator and configured to generate control signals to control said at least one pacing pulse generator to generate pacing pulses according to multiple different candidate CRT settings of a programmable CRT parameter;
• a settings optimizer configured to determine, for a defined heart rate range of said heart a respective optimal CRT setting based on said multiple different candidate CRT settings and based on said output signals from said hemodynamic sensor during an optimization time period;
• and
• a settings predictor configured to predict, for said defined heart rate range, at least one future optimal CRT setting based on said respective optimal CRT settings determined by said settings optimizer during an optimization time period, wherein said implantable medical device further comprises a memory for storing said at least one future optimal CRT setting and said controller is configured to generate, following an end of the optimization time period, control signals to control said at least one pacing pulse generator to generate pacing pulses according to a CRT setting of said at least one future optimal CRT setting.

A method for determining cardiac resynchronization therapy, CRT, settings for an implantable medical device comprising:

• a) said implantable medical device generating and applying pacing pulses to a first heart chamber of a heart of a subject and a second heart chamber of said heart according to a CRT setting of a programmable CRT parameter of said implantable medical device;
• b) a hemodynamic sensor generating output signals representative of a hemodynamic status of said subject;
• c) repeating steps a) and b) for multiple different candidate CRT settings of said programmable CRT parameter at a CRT settings search period during an optimization time period;
• d) determining, for a defined heart rate range of said heart (10), an optimal CRT setting based on said multiple different candidate CRT settings and based on said output signals from said hemodynamic sensor;
• e) repeating steps a) to d) for multiple CRT settings search periods during said optimization time period;
• f) predicting, for said defined heart rate range, at least one future optimal CRT setting based on said determined optimal CRT settings;
• g) storing said at least one future optimal CRT setting in a memory of said implantable medical device;
• and
• h) said implantable medical device generating and applying, following an end of said optimization time period, pacing pulses to said first heart chamber said second heart chamber according to a CRT setting of said at least one future optimal CRT settings.