US 8,620,433 B2 · Criteria for optimal electrical resynchronization derived from multipolar leads or multiple electrodes during biventricular pacing

Abstract

Generally, the disclosure is directed one or more methods or systems of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes. Pacing using the right ventricular electrode and a first one of the left ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Pacing using the right ventricular electrode and a second one of the ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes. Employing sums of the measured activation times to select one of the left ventricular electrodes for delivery of subsequent pacing pulses.

Claims41

Dependent claims

A method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
and
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
and
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“(ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

42 more elements

A method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
and
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony includes a distance of the other ones of the left ventricular electrodes from the second one,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

42 more elements

A method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
and
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony includes a distance of the other ones of the left ventricular electrodes from the second one,
averaging activation times associated with the first one when two or more of the left ventricular electrodes are substantially close;
averaging activation times associated with the second one when two or more of the left ventricular electrodes are substantially close;
determining whether the electrical dyssynchrony associated with one V-V delay is greater than the electrical dyssynchrony associated with another V-V delay;
and
eliminating the V-V delay with greater electrical dyssynchrony as a possible choice of V-V delay for delivery of cardiac resynchronization therapy,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

47 more elements

A method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony includes a distance of the other ones of the left ventricular electrodes from the second one,
averaging activation times associated with the first one when two or more of the left ventricular electrodes are substantially close;
averaging activation times associated with the second one when two or more of the left ventricular electrodes are substantially close
comparing the weighted electrical dyssynchrony for the first V-V delay to a threshold level;
comparing the weighted electrical dyssynchrony for the second V-V delay to the threshold level;
determining the first V-V delay has a larger absolute value than the second V-V delay;
and
eliminating the first V-V delay for delivery of cardiac resynchronization therapy when weighted electrical dyssynchrony associated with first and second V-V delays are equal,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

48 more elements

A system of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) means for pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) means for measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) means for determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) means for pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) means for measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
f) means for determining a weighted electrical dyssynchrony for the second V-V delay;
g) means for comparing weighted electrical dyssynchrony for the first and the second V-V delays;
and
h) means for selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“(ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

41 more elements

A machine readable medium containing executable computer program instructions which when executed by a data processing system cause the system to perform a method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
and
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

41 more elements

Dependencies are inferred from the claim text.

Facts

Application

13/464,228Filed 4 May 2012 · us provisional application

Priority

17 Feb 2012

Published

US 2013/0218225 A122 Aug 2013

Granted

31 Dec 2013

Term ends

Not estimatedThe source records don’t support an estimate.

Classification9 codes

A61N 1/3686
Comprising more than one electrode co-operating with different heart regions: configured for selecting the electrode configuration on a lead
A61N 1/3622
For treating or preventing abnormally high heart rate: comprising two or more electrodes co-operating with different heart regions
A61N 1/3627
Heart stimulators: for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
A61N 1/36843
For stimulating the heart at multiple sites of the ventricle or the atrium: bi-ventricular stimulation

Abstract

Claims41

Dependent claims

A method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
and
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
and
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“(ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

42 more elements

A method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
and
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony includes a distance of the other ones of the left ventricular electrodes from the second one,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

42 more elements

A method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
and
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony includes a distance of the other ones of the left ventricular electrodes from the second one,
averaging activation times associated with the first one when two or more of the left ventricular electrodes are substantially close;
averaging activation times associated with the second one when two or more of the left ventricular electrodes are substantially close;
determining whether the electrical dyssynchrony associated with one V-V delay is greater than the electrical dyssynchrony associated with another V-V delay;
and
eliminating the V-V delay with greater electrical dyssynchrony as a possible choice of V-V delay for delivery of cardiac resynchronization therapy,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

47 more elements

A method of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony includes a distance of the other ones of the left ventricular electrodes from the second one,
averaging activation times associated with the first one when two or more of the left ventricular electrodes are substantially close;
averaging activation times associated with the second one when two or more of the left ventricular electrodes are substantially close
comparing the weighted electrical dyssynchrony for the first V-V delay to a threshold level;
comparing the weighted electrical dyssynchrony for the second V-V delay to the threshold level;
determining the first V-V delay has a larger absolute value than the second V-V delay;
and
eliminating the first V-V delay for delivery of cardiac resynchronization therapy when weighted electrical dyssynchrony associated with first and second V-V delays are equal,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

48 more elements

A system of cardiac pacing employing a right ventricular electrode and a plurality of left ventricular electrodes, comprising:

a) means for pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) means for measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) means for determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) means for pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) means for measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
f) means for determining a weighted electrical dyssynchrony for the second V-V delay;
g) means for comparing weighted electrical dyssynchrony for the first and the second V-V delays;
and
h) means for selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“(ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

41 more elements

a) pacing using the right ventricular electrode and a pacing left ventricular electrode using a first V-V delay;
b) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
c) determining a weighted electrical dyssynchrony associated with the first V-V delay;
d) pacing using the right ventricular electrode and the pacing left ventricular electrodes using a second V-V delay;
e) measuring activation times at other ones of the left ventricular electrodes in response to pacing the right ventricular electrode and pacing a left ventricular electrode;
and
f) determining a weighted electrical dyssynchrony for the second V-V delay;
g) comparing weighted electrical dyssynchrony for the first and the second V-V delays;
h) selecting an optimal V-V delay in response to comparing weighted electrical dyssynchrony for the first and the second V-V delays,
wherein the weighted electrical dyssynchrony is determined through a weighted electrical dyssynchrony equation (“ED(j,A,D)”) defined as:
ED
⁡
(
j
,
A
,
D
)
=
∑
i
=
1
n
⁢
w
⁡
(
i
,
j
)
⁢
AT
⁡
(
i
,
A
,
D
)
wherein factor w(i, j) is a distance of a sensing electrode i from a pacing electrode j, n is a total number of left ventricular electrodes, A is atrio-ventricular delay, and D is time delay between pacing pulses in a right ventricle and a left ventricle.

41 more elements

Dependencies are inferred from the claim text.

Criteria for optimal electrical resynchronization derived from multipolar leads or multiple electrodes during biventricular pacing

Life of this patent

Abstract

Claims41

Criteria for optimal electrical resynchronization derived from multipolar leads or multiple electrodes during biventricular pacing

Life of this patent

Abstract

Claims41