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

Patent metadata

Field	Value
Publication number	US-8948869-B2
Application number	US-201213464181-A
Country	US
Kind code	B2
Filing date	May 4, 2012
Priority date	Feb 17, 2012
Publication date	Feb 3, 2015
Grant date	Feb 3, 2015

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.

First claim

What is claimed:

1. 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 first one of the left ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes;
b) 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; and
c) employing sums of the measured activation times to select one of the left ventricular electrodes for delivery of subsequent pacing pulses,
d) wherein selection of the one of the left ventricular electrodes for delivery of subsequent pacing pulses is determined through a weighted electrical dyssynchrony equation (“(ED (j, A, D)”) defined as:
ED( j,A,D )=Σ 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.

2. The method of claim 1 , further comprising determining whether the first one or the second one of the left ventricular electrodes has a lowest measured activation time when pacing from the right ventricular electrode.

3. The method of claim 2 , further comprising determining a first electrical dyssynchrony index (EDI) associated with the first one and a second EDI for the second one of the left ventricular electrodes.

4. The method of claim 3 , further comprising determining which left ventricular electrode produces a lesser EDI during biventricular pacing.

5. The method of claim 1 , further comprising selecting one or more of the left ventricular electrodes for delivery of subsequent pacing pulses.

6. The method of claim 4 wherein selecting one of the left ventricular electrodes is based upon the lesser EDI.

7. The method of claim 6 further comprising comparing a EDI for each of the left ventricular electrodes.

8. The method of claim 6 further comprising sorting the EDI for each of the left ventricular electrodes.

9. The method of claim 6 further comprising:
determining a difference between one EDI associated with one left ventricular electrode and another EDI associated with another left ventricular electrode;
comparing the difference to a threshold level T referred to as delta T or ΔT; and
selecting one of the left ventricular electrodes for delivery of subsequent pacing pulses based upon ΔT ms of a minimum EDI, the minimum EDI being a lesser value EDI between the one EDI and the another EDI.

10. The method of claim 9 wherein ΔT is about 10 milliseconds or less.

11. The method of claim 6 wherein the left ventricular electrodes exhibit about an equivalent EDI; and
ΔT is about 15 milliseconds or less.

12. The method of claim 6 wherein ΔT is about 5-15 milliseconds.

13. The method of claim 6 further comprising selecting two or more left ventricular electrodes from which to pace.

14. The method of claim 1 wherein a left ventricular quadripolar lead is employed.

15. The method of claim 1 wherein a left ventricular quadripolar lead includes a left ventricular electrode spaced about 1.5 millimeters away from another left ventricular electrode.

16. A non-transitory 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 first one of the left ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes;
b) 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; and
c) employing sums of the measured activation times to select one of the left ventricular electrodes for delivery of subsequent pacing pulses,
d) wherein selection of the one of the left ventricular electrodes for delivery of subsequent pacing pulses is determined through a weighted electrical dyssynchrony equation (“(ED (j, A, D)”) defined as:
ED( j,A,D )=Σ 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.

17. The medium of claim 16 , further comprising employing differences between the measured activation times in conjunction with the sums to select the one of the left ventricular electrodes.

18. The medium of claim 17 , further comprising determining a electrical dyssynchrony index (EDI) achieved in response to differences between the measured activation times.

19. The medium of claim 18 , further comprising determining which left ventricular electrode produces a lesser EDI during biventricular pacing.

20. The medium of claim 16 , further comprising selecting one or more of the left ventricular electrodes for delivery of subsequent pacing pulses.

21. The medium of claim 20 wherein selecting one of the left ventricular electrodes is based upon a lesser EDI.

22. The medium of claim 16 further comprising comparing an electrical dyssynchrony index (EDI) for each of the left ventricular electrodes.

23. The medium of claim 16 further comprising sorting the electrical dyssynchrony index (EDI) for each of the left ventricular electrodes.

24. The medium of claim 16 further comprising:
determining a difference between one EDI associated with one left ventricular electrode and another EDI associated with another left ventricular electrode;
comparing the difference to a threshold level T referred to as delta T or ΔT;
determining a minimum EDI between one EDI and another EDI responsive to comparing the difference to a threshold level T; and
selecting one of the left ventricular electrodes for delivery of subsequent pacing pulses based upon ΔT ms, of a minimum EDI, the minimum EDI being a lesser value EDI between the one EDI and the another EDI.

25. The medium of claim 16 wherein ΔT is 10 ms or less.

26. The medium of claim 16 wherein the left ventricular electrodes exhibit about an equivalent electrical dyssynchrony index (EDI); and ΔT is about 15 milliseconds or less.

27. The medium of claim 16 wherein ΔT is about 5-15 milliseconds.

28. The medium of claim 16 further comprising selecting two or more left ventricular electrodes from which to pace.

29. 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 first one of the left ventricular electrodes and measuring activation times at other ones of the left ventricular electrodes;
b) means for 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; and
c) means for employing sums of the measured activation times to select one of the left ventricular e

Assignees

• Ghosh Subham
• Stadler Robert W
• Medtronic Inc

Inventors

• Ghosh Subham
• Stadler Robert W

Classifications

• A61N1/371

  Capture, i.e. successful stimulation · CPC title

• A61N1/3627

  for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy · CPC title

• A61N1/3686 Primary

  configured for selecting the electrode configuration on a lead (A61N1/3688 takes precedence) · CPC title

• A61N1/36843

  Bi-ventricular stimulation · CPC title

• A61N1/3622

  comprising two or more electrodes co-operating with different heart regions · CPC title