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US 8,617,082 B2Granted
Heart sounds-based pacing optimization
AssigneeMedtronic, Inc.
InventorsXusheng Zhang, Aleksandre T. Sambelashvili, David A. Anderson, Zhendong Song
Life of this patent
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Abstract
An implantable medical device receives both heart sound and electrogram signals. A processor within the implantable medical device extracts physiologically relevant information from both the heart sound signal and the electrogram signal. Based on the extracted physiologically relevant information a set of pacing parameters is evaluated. In certain examples, the values of the pacing parameters may be changed by the implantable medical device in response to the physiologically relevant information extracted from the heart sound signal and the electrogram signal.
Claims38
A method comprising:
- obtaining heart sounds from an implanted heart sound sensor;
- obtaining an electrogram (EGM) from electrodes of an implantable device;
- generating one or more acoustic cardiographic metrics based on at least one of the heart sounds and the electrogram for a set of cardiac pacing parameters, the set of cardiac pacing parameters including a plurality of pacing parameters;
- wherein the acoustic cardiographic metrics include one or more of:
- an indication of atrioventricular (AV) dyssynchrony based on at least an interval from heart sound S2 to heart sound S1;
- an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- an indication of left intraventricular dyssynchrony based on at least one of electromechanical activation delay (EMAT),
- EMAT plus S1 duration,
- heart sound M1 duration, and
- heart sound A2 duration,
- a surrogate for a myocardial performance index (MPI) based at least on a duration heart sound S1 and a duration of heart sound S2;
- an indication of left ventricle (LV) fill time based on the interval between heart sound S2 and heart sound S1;
- and
- an indication of LV contractility based on at least one of:
- a ratio of EMAT plus heart sound S1 duration divided by the interval between heart sound S1 and heart sound S2;
- the ratio of EMAT plus S1 duration divided by an R to R interval of the EGM, or
- an indication of hypertension based on at least one of:
- heart sound S1 splitting and heart sound S2 splitting,
- relative changes of intensity of M1 and heart sound T1 over a predetermined period of time,
- relative change in a A2 to heart sound P2 amplitude ratio over a predetermined period of time,
- variability in Q wave to heart sound A2 interval (Q-A2) over time, or heart sound S4;
- and
- wherein the acoustic cardiographic metric comprising the indication of VV dyssynchrony is based on the splitting of heart sound S1 and heart sound S2, the method further comprising adjusting one or more cardiac pacing parameters to obtain an S1 split between M1 and T1 that is between approximately 20 and 40 ms and an S2 split between A2 and P2 that is approximately 20 ms.
20 more elements
A method comprising:
- obtaining heart sounds from an implanted heart sound sensor;
- obtaining an electrogram (EGM) from electrodes of an implantable device;
- generating one or more acoustic cardiographic metrics based on at least one of the heart sounds and the electrogram for a set of cardiac pacing parameters, the set of cardiac pacing parameters including a plurality of pacing parameters;
- wherein the acoustic cardiographic metrics include one or more of:
- an indication of atrioventricular (AV) dyssynchrony based on at least an interval from heart sound S2 to heart sound S1;
- an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- an indication of left intraventricular dyssynchrony based on at least one of
- electromechanical activation delay (EMAT),
- EMAT plus S1 duration,
- heart sound M1 duration, and
- heart sound A2 duration,
- a surrogate for a myocardial performance index (MPI) based at least on a duration heart sound S1 and a duration of heart sound S2;
- an indication of left ventricle (LV) fill time based on the interval between heart sound S2 and heart sound S1;
- and
- an indication of LV contractility based on at least one of:
- a ratio of EMAT plus heart sound S1 duration divided by the interval between heart sound S1 and heart sound S2;
- the ratio of EMAT plus S1 duration divided by an R to R interval of the EGM, or
- an indication of hypertension based on at least one of:
- heart sound S1 splitting and heart sound S2 splitting,
- relative changes of intensity of M1 and heart sound T1 over a predetermined period of time,
- relative change in a A2 to heart sound P2 amplitude ratio over a predetermined period of time,
- variability in Q wave to heart sound A2 interval (Q-A2) over time, or heart sound S4;
- and
- further comprising adjusting one or more cardiac pacing parameters based on the indication of LV filling time to obtain an interval between S2 and S1 that is greater than 40% of an R to R interval of the EGM.
21 more elements
A device comprising:
- a heart sound sensor configured to obtain a heart sound signal;
- an electrogram (EGM) sensor configured to obtain an electrogram;
- and
- a processor configured to generate one or more acoustic cardiographic metrics based on at least one of the heart sound signal received from the heart sound sensor and the EGM received from the EGM sensor for a set of cardiac pacing parameters, wherein the acoustic cardiographic metrics include one or more of:
- an indication of atrioventricular (AV) dyssynchrony based on at least an interval from heart sound S2 to heart sound S1;
- an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- an indication of left intraventricular dyssynchrony based on at least one of
- electromechanical activation delay (EMAT),
- EMAT plus S1 duration,
- heart sound M1 duration, and
- heart sound A2 duration,
- a surrogate for a myocardial performance index (MPI) based at least on a duration heart sound S1 and a duration of heart sound S2;
- an indication of left ventricle (LV) filling time based on the interval between heart sound S2 and heart sound S1;
- and
- an indication of LV contractility based on at least one of:
- the ratio of EMAT plus heart sound S1 duration divided by the interval between heart sound S1 and heart sound S2;
- the ratio of EMAT plus S1 duration divided by an R to R interval of the EGM:
- an indication of hypertension based on at least one of:
- heart sound S1 splitting and heart sound S2 splitting,
- relative changes of intensity of M1 and heart sound T1 over a predetermined period of time,
- relative change in a A2 to heart sound P2 amplitude ratio over a predetermined period of time,
- variability in Q wave to heart sound A2 interval (Q-A2) over time, or heart sound S4;
- and
- wherein the acoustic cardiographic metric comprises the indication of VV dyssynchrony, and is based on the splitting of heart sound S1 and heart sound S2, and the processor is further configured to one or more cardiac pacing parameters to obtain an S1 split between M1 and T1 that is between approximately 20 and 40 ms and an S2 split between A2 and P2 that is approximately 20 ms.
21 more elements
A device comprising:
- a heart sound sensor configured to obtain a heart sound signal;
- an electrogram (EGM) sensor configured to obtain an electrogram;
- and
- a processor configured to generate one or more acoustic cardiographic metrics based on at least one of the heart sound signal received from the heart sound sensor and the EGM received from the EGM sensor for a set of cardiac pacing parameters, wherein the acoustic cardiographic metrics include one or more of:
- an indication of atrioventricular (AV) dyssynchrony based on at least an interval from heart sound S2 to heart sound S1;
- an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- an indication of left intraventricular dyssynchrony based on at least one of
- electromechanical activation delay (EMAT),
- EMAT plus S1 duration,
- heart sound M1 duration, and
- heart sound A2 duration,
- a surrogate for a myocardial performance index (MPI) based at least on a duration heart sound S1 and a duration of heart sound S2;
- an indication of left ventricle (LV) filling time based on the interval between heart sound S2 and heart sound S1;
- and
- an indication of LV contractility based on at least one of:
- the ratio of EMAT plus heart sound S1 duration divided by the interval between heart sound S1 and heart sound S2;
- the ratio of EMAT plus S1 duration divided by an R to R interval of the EGM:
- an indication of hypertension based on at least one of:
- heart sound S1 splitting and heart sound S2 splitting,
- relative changes of intensity of M1 and heart sound T1 over a predetermined period of time,
- relative change in a A2 to heart sound P2 amplitude ratio over a predetermined period of time,
- variability in Q wave to heart sound A2 interval (Q-A2) over time, or heart sound S4;
- and
- wherein the processor is further configured to adjust one or more cardiac pacing parameters based on the indication of LV fill time to obtain an interval between S2 and S1 that is greater than 40% of an R to R interval of the EGM.
21 more elements
A method comprising:
- obtaining heart sounds from an implanted heart sound sensor;
- obtaining an electrogram (EGM) from electrodes of an implantable device;
- generating one or more acoustic cardiographic metrics based on at least one of the heart sounds and the electrogram for a set of cardiac pacing parameters, the set of cardiac pacing parameters including a plurality of pacing parameters;
- wherein the acoustic cardiographic metrics include an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- wherein the acoustic cardiographic metric comprising the indication of VV dyssynchrony is based on the splitting of heart sound S1 and heart sound S2, the method further comprising adjusting one or more cardiac pacing parameters to obtain an S1 split between heart sound M1 and heart sound T1 that is between approximately 20 and 40 ms and an S2 split between heart sound A2 and heart sound P2 that is approximately 20 ms.
2 more elements
A device comprising:
- a heart sound sensor configured to obtain a heart sound signal;
- an electrogram (EGM) sensor configured to obtain an electrogram;
- and
- a processor configured to generate one or more acoustic cardiographic metrics based on at least one of the heart sound signal received from the heart sound sensor and the EGM received from the EGM sensor for a set of cardiac pacing parameters, wherein the acoustic cardiographic metrics include an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- wherein the acoustic cardiographic metric comprises the indication of VV dyssynchrony, and is based on the splitting of heart sound S1 and heart sound S2, and the processor is further configured to one or more cardiac pacing parameters to obtain an S1 split between heart sound M1 and heart sound T1 that is between approximately 20 and 40 ms and an S2 split between heart sound A2 and heart sound P2 that is approximately 20 ms.
2 more elements
A method comprising:
- obtaining heart sounds from an implanted heart sound sensor;
- obtaining an electrogram (EGM) from electrodes of an implantable device;
- generating one or more acoustic cardiographic metrics based on at least one of the heart sounds and the electrogram for a set of cardiac pacing parameters, the set of cardiac pacing parameters including a plurality of pacing parameters;
- wherein the acoustic cardiographic metrics include an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- wherein the acoustic cardiographic metric comprising the indication of VV dyssynchrony is based on the splitting of heart sound S1 and heart sound S2, the method further comprising adjusting one or more cardiac pacing parameters to obtain an S1 split between heart sound M1 and heart sound T1 that is between approximately 20 and 40 ms.
2 more elements
A device comprising:
- a heart sound sensor configured to obtain a heart sound signal;
- an electrogram (EGM) sensor configured to obtain an electrogram;
- and
- a processor configured to generate one or more acoustic cardiographic metrics based on at least one of the heart sound signal received from the heart sound sensor and the EGM received from the EGM sensor for a set of cardiac pacing parameters, wherein the acoustic cardiographic metrics include an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- wherein the acoustic cardiographic metric comprises the indication of VV dyssynchrony, and is based on the splitting of heart sound S1 and heart sound S2, and the processor is further configured to one or more cardiac pacing parameters to obtain an S1 split between heart sound M1 and heart sound T1 that is between approximately 20 and 40 ms.
2 more elements
A method comprising:
- obtaining heart sounds from an implanted heart sound sensor;
- obtaining an electrogram (EGM) from electrodes of an implantable device;
- generating one or more acoustic cardiographic metrics based on at least one of the heart sounds and the electrogram for a set of cardiac pacing parameters, the set of cardiac pacing parameters including a plurality of pacing parameters;
- wherein the acoustic cardiographic metrics include an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- wherein the acoustic cardiographic metric comprising the indication of VV dyssynchrony is based on the splitting of heart sound S1 and heart sound S2, the method further comprising adjusting one or more cardiac pacing parameters to obtain an S2 split between heart sound A2 and heart sound P2 that is approximately 20 ms.
2 more elements
A device comprising:
- a heart sound sensor configured to obtain a heart sound signal;
- an electrogram (EGM) sensor configured to obtain an electrogram;
- and
- a processor configured to generate one or more acoustic cardiographic metrics based on at least one of the heart sound signal received from the heart sound sensor and the EGM received from the EGM sensor for a set of cardiac pacing parameters, wherein the acoustic cardiographic metrics include an indication of interventricular (VV) dyssynchrony based on a splitting of at least one of heart sound S1 and heart sound S2;
- wherein the acoustic cardiographic metric comprises the indication of VV dyssynchrony, and is based on the splitting of heart sound S1 and heart sound S2, and the processor is further configured to one or more cardiac pacing parameters to obtain an S2 split between heart sound A2 and P2 that is approximately 20 ms.
2 more elements
Dependencies are inferred from the claim text.