# US 7,613,514 B2 · Selective resynchronization therapy optimization based on user preference

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- Number: US 7,613,514 B2
- Document ID: US7613514B2
- Status: Granted
- Kind: B2
- Application number: 11/109,603
- Filed: 2005-04-19
- Published: 2006-10-19
- Granted: 2009-11-03
- Earliest claimed: 2005-04-19
- Assignees: Cardiac Pacemakers, Inc.
- Inventors: Richard Fogoros; Jiang Ding; Yinghong Yu
- Web page: https://patentgrep.com/patent/US7613514B2

## CPC

- A61N 1/3627: {for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy}
- A61N 1/36564: {controlled by blood pressure}
- A61N 1/3682: {with a variable atrioventricular delay}
- A61N 1/3684: {for stimulating the heart at multiple sites of the ventricle or the atrium}
- A61N 1/36842: {Multi-site stimulation in the same chamber}
- 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)

## Abstract

A method and system for calculating an atrio-ventricular delay interval based upon an inter-atrial delay exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may optimize the stroke volume exhibited by a patient's heart. The aforementioned atrio-ventricular delay interval may be blended with another atrio-ventricular delay interval that may optimize another performance characteristic, such as left ventricular contractility. Such blending may include finding an arithmetic mean, geometric mean, or weighted mean of two or more proposed atrio-ventricular delay intervals.

## Claims

### Claim 1

A method comprising:
sensing and measuring an atrioventricular delay concluded by a sensed ventricular event;
sensing and measuring an interatrial delay (IAD) concluded by a sensed atrial event;
determining a first atrio-ventricular delay value, AVD1, selected to approximately maximize contractility of a ventricle, using the measured atrioventricular delay concluded by the sensed ventricular event;
determining a second atrio-ventricular delay value, AVD2, selected to approximately maximize stroke volume of the ventricle, using the measured IAD concluded by the sensed atrial event;
providing an interface through which a health care provider can enter a first coefficient K5 to be applied to the first atrio-ventricular delay value and a second coefficient K6 to be applied to the second atrio-ventricular delay value; and
combining the first and second atrio-ventricular delay values to establish a blended atrio-ventricular delay AVDblended=(K5*AVD1+K6*AVD2)/(K5+K6), wherein the blended atrio-ventricular delay AVDblended is determined using a the measured IAD and the measured atrio ventricular delay.

### Claim 2 (depends on 1)

The method of claim 1, wherein the ventricle is the left ventricle, and wherein peak positive left ventricular pressure change is used as a measurable indicator of contractility of the left ventricle.

### Claim 3 (depends on 1)

The method of claim 1, wherein aortic pulse pressure is used as a measurable indicator of stroke volume.

### Claim 4 (depends on 1)

The method of claim 1, wherein the first atrio-ventricular delay is a function, at least in part, of a time interval between a paced or sensed event in the right atrium and a sensed event in a right ventricle, and wherein the first atrio-ventricular delay is also a function, at least in part, of a time interval between a paced or sensed event in the right atrium and a sensed event in the left ventricle.

### Claim 5 (depends on 4)

The method of claim 4, wherein the first atrio-ventricular delay is arrived at according to the formula AVD1=K1*AVR+K2*AVL,
wherein AVD1 represents the first atrio-ventricular delay, K1 is a constant, AVR represents the time interval between a paced or sensed event in the right atrium and a sensed event in the right ventricle, K2 is a constant, and AVL represents the time interval between a paced or sensed event in the right atrium and a sensed event in the left ventricle.

### Claim 6 (depends on 1)

The method of claim 1, wherein the second atrio-ventricular delay is a function, at least in part, of a time interval between a paced or sensed event in the right atrium and a sensed event in the left atrium.

### Claim 7 (depends on 6)

The method of claim 6, wherein the second atrio-ventricular delay is arrived at according to the formula AVD2=K3*IAD+K4,
wherein AVD2 represents the second atrio-ventricular delay, K3 is a constant, IAD represents the time interval between the paced or sensed event in the right atrium and the sensed event in the left atrium, and K4 is a constant.

### Claim 8 (depends on 6)

The method of claim 6, wherein the time interval is observed by performing the following acts during implantation of a cardiac rhythm management device:
implanting a first lead so that an electrode therein makes electrical contact with a region within the right atrium of a heart;
pausing while passing a second lead toward the left ventricle, so that an electrode on the second lead makes electrical contact with the mid-coronary sinus of the heart;
using the first lead to detect a depolarization of the right atrium or stimulate a contraction of the right atrium; and
using the second lead to detect a depolarization of the left atrium.

### Claim 9 (depends on 6)

The method of claim 6, wherein the time interval is observed by performing the following acts during implantation of a cardiac rhythm management device:
implanting a first lead so that an electrode therein makes electrical contact with a region within the right atrium of a heart;
implanting a second lead so that a first electrode thereof makes electrical contact with the mid-coronary sinus of the heart and a second electrode thereof makes electrical contact with a region of the left ventricle of the heart; and
using the first lead to detect a depolarization of the right atrium or stimulate a contraction of the right atrium; and
using the second lead to detect a depolarization of the left atrium.

### Claim 10 (depends on 1)

The method of claim 1, wherein the act of determining the first atrio-ventricular delay is performed by a programmer in communication with a cardiac rhythm management device that can be programmed by the programmer to employ the weighted atrio-ventricular delay.

### Claim 11 (depends on 1)

The method of claim 1, wherein the act of determining the second atrio-ventricular delay is performed by a programmer in communication with a cardiac rhythm management device that can be programmed by the programmer to employ the weighted atrio-ventricular delay.

### Claim 12 (depends on 1)

The method of claim 1, comprising programming an implantable device to provide cardiac electrostimulation pulses according to the combined atrio-ventricular delay resulting from the combining of the first and second atrio-ventricular delay values.

### Claim 13 (depends on 1)

The method of claim 1, comprising communicating an indication of the first and second atrio-ventricular delay values to a user.

### Claim 14 (depends on 1)

The method of claim 1, comprising receiving a user input and using the user input in performing the combining of the first and second atrio-ventricular delay values.

### Claim 15 (depends on 1)

The method of claim 1, in which the determining the first atrio-ventricular delay value comprises detecting a right atrial pace or sensed depolarization and a mid-coronary sinus left ventricular pace or sensed depolarization.

### Claim 16 (depends on 1)

The method of claim 1, comprising determining an inter-atrial delay by finding a span of time separating a paced or sensed event in the right atrium and a signal indicating left atrial activity, and using the inter-atrial delay in combining the first and second atrio-ventricular delay values.

### Claim 17 (depends on 1)

The method of claim 1, wherein the first atrio-ventricular delay, AVD1, is arrived at as a function of a time interval AVR between a paced or sensed event in the right atrium and a sensed event in the right ventricle.

### Claim 18 (depends on 17)

The method of claim 17, wherein the first atrio-ventricular delay, AVD1, is arrived at as a function of a time interval AVL between a paced or sensed event in the right atrium and a sensed event in the left ventricle.

### Claim 19 (depends on 18)

The method of claim 18, wherein the first atrio-ventricular delay, AVD1, is arrived at as a function of a QRS width.

### Claim 20 (depends on 19)

The method of claim 19, wherein the first atrioventricular delay, AVD1, is arrived at according to the equation AVD1=K3 *QRS+K4*AVR+K5, wherein K3, K4, and K5 are constants, QRS represents the width of the QRS complex, and AVR represents the span of time separating a paced or sensed right atrial event and a sensed right ventricular event.