Noninvasive assessment of cardiac resynchronization therapy

A system comprising:

• means for noninvasively delivering ultrasonic energy to cardiac tissue;
• in response to delivering ultrasonic energy to the cardiac tissue, means for receiving, with a processing unit, a torso-surface potential signal from each of a plurality of electrodes distributed on a torso of a patient;
• for at least a subset of the plurality of electrodes, processing means for calculating, with the processing unit, a torso-surface activation time based on the signal sensed from the electrode;
• and
• means for presenting, by the processing unit, to a user, an indication of a degree of dyssynchrony of the torso-surface activation times via a display.

A method comprising:

• delivering noninvasively ultrasonic energy to cardiac tissue;
• in response to delivering ultrasonic energy to the cardiac tissue, receiving, with a processing unit, a torso-surface potential signal from each of a plurality of electrodes distributed on a torso of a patient;
• for at least a subset of the plurality of electrodes, calculating, with the processing unit, a torso-surface activation time based on the signal sensed from the electrode;
• and
• presenting, by the processing unit, to a user, an indication of a degree of dyssynchrony of the torso-surface activation times via a display, wherein the ultrasonic energy is high intensity focused ultrasound (HIFU),
• wherein receiving the torso-surface potential signals and calculating the torso-surface activation times comprises receiving first torso-surface potential signals and calculating first torso-surface activation times a first time during intrinsic conduction of a heart of the patient and receiving second torso-surface potential signals and calculating second torso-surface activation times a second time during CRT pacing of the heart, and
• wherein presenting the indication of the degree of dyssynchrony comprises presenting an indication of a change in dyssynchrony from the intrinsic conduction to the CRT pacing of the heart.

A method comprising:

• delivering ultrasonic energy to cardiac tissue;
• in response to delivering ultrasonic energy to the cardiac tissue, receiving, with a processing unit, a torso-surface potential signal from each of a plurality of electrodes distributed on a torso of a patient;
• for at least a subset of the plurality of electrodes, calculating, with the processing unit, a torso-surface activation time based on the signal sensed from the electrode;
• and
• presenting, by the processing unit, to a user, an indication of a degree of dyssynchrony of the torso-surface activation times via a display,
• wherein receiving the torso-surface potential signals and calculating the torso-surface activation times comprises receiving first torso-surface potential signals and calculating first torso-surface activation times a first time during intrinsic conduction of a heart of the patient and receiving second torso-surface potential signals and calculating second torso-surface activation times a second time during CRT pacing of the heart, and
• wherein presenting the indication of the degree of dyssynchrony comprises presenting an indication of a change in dyssynchrony from the intrinsic conduction to the CRT pacing of the heart.

A method comprising:

• (a) applying an electrode apparatus having a plurality of electrodes to a torso of a patient;
• (b) introducing one of a right ventricular (RV) lead to a right ventricle or a right atrial (RA) lead to a right atrium;
• (c) delivering noninvasively ultrasonic energy to a target tissue selected from a set of target tissues;
• (d) in response to delivering ultrasonic energy to the cardiac tissue, receiving, with a processing unit, a torso-surface potential signal from each of a plurality of electrodes distributed on a torso of a patient for the target tissue;
• (e) sensing signals from one of the RA lead and the RV lead in response to delivering ultrasonic energy;
• (f) for at least a subset of the plurality of electrodes, calculating, with the processing unit, a torso-surface activation time based on the signal sensed from the electrode;
• (g) repeating steps (c) through (f) for another tissue site to obtain cardiac resynchronization data;
• (i) determining whether the tissue site or the another tissue site provides optimal cardiac resynchronization;
• and
• (j) in response step (i), selecting one of the tissue site and the another tissue site that provides optimal cardiac resynchronization for locating a medical electrical lead.

A method comprising:

• delivering noninvasively ultrasound pacing to cardiac tissue;
• in response to delivering ultrasonic energy to the cardiac tissue, receiving, with a processing unit, a torso-surface potential signal from each of a plurality of electrodes distributed on a torso of a patient;
• acquiring P-wave signals in response to delivering ultrasonic energy to the cardiac tissue;
• timing the ultrasound pacing to PR minus a pre-specified time period following the P-wave, on successive beats;
• and
• presenting, by the processing unit, to a user, an indication of a degree of dyssynchrony of the torso-surface activation times via a display.

A method comprising:

• (a) applying an electrode apparatus having a plurality of electrodes to a torso of a patient;
• (b) introducing one of a right ventricular (RV) lead to a right ventricle or a right atrial (RA) lead to a right atrium;
• (c) delivering noninvasively ultrasonic energy to a target tissue selected from a set of target tissues;
• (d) in response to delivering ultrasonic energy to the cardiac tissue, receiving, with a processing unit, a torso-surface potential signal from each of a plurality of electrodes distributed on a torso of a patient for the target tissue;
• (e) sensing signals from one of the RA lead and the RV lead in response to delivering ultrasonic energy;
• (f) for at least a subset of the plurality of electrodes, calculating, with the processing unit, a torso-surface activation time based on the signal sensed from the electrode;
• (g) repeating steps (c) through (f) for another tissue site to obtain cardiac resynchronization data;
• (i) determining whether the tissue site or the another tissue site provides optimal cardiac resynchronization;
• and
• (j) in response step (i), selecting one of the tissue site and the another tissue site that provides optimal cardiac resynchronization for locating a medical electrical lead.

A method comprising:

• (a) applying an electrode apparatus having a plurality of electrodes to a torso of a patient;
• (b) introducing one of a right ventricular (RV) lead to a right ventricle or a right atrial (RA) lead to a right atrium;
• (c) delivering noninvasively ultrasonic energy to a target tissue selected from a set of target tissues;
• (d) in response to delivering ultrasonic energy to the cardiac tissue, receiving, with a processing unit, a torso-surface potential signal from each of a plurality of electrodes distributed on a torso of a patient for the target tissue;
• (e) sensing signals from one of the RA lead and the RV lead in response to delivering ultrasonic energy;
• (f) for at least a subset of the plurality of electrodes, calculating, with the processing unit, a torso-surface activation time based on the signal sensed from the electrode;
• (g) repeating steps (c) through (f) for another tissue site to obtain cardiac resynchronization data;
• (i) determining whether the tissue site or the another tissue site provides optimal cardiac resynchronization;
• (j) in response step (i), selecting one of the tissue site and the another tissue site that provides optimal cardiac resynchronization for locating a medical electrical lead;
• (k) introducing the medical electrical lead to a target area in a ventricle, wherein the target area is one of the endocardium and epicardium;
• and
• (l) moving the medical electrical lead to the target area in the ventricle that facilitates optimal cardiac resynchronization.