Method and apparatus to deliver mechanically fused pacing therapy

Patent metadata

Field	Value
Publication number	US-9272147-B2
Application number	US-201113088581-A
Country	US
Kind code	B2
Filing date	Apr 18, 2011
Priority date	Apr 30, 2007
Publication date	Mar 1, 2016
Grant date	Mar 1, 2016

Abstract

A medical device system and method for delivering mechanically fused left ventricular cardiac stimulation. A sensor monitors left ventricular acceleration while left ventricular cardiac stimulation is provided at an AV interval. The left ventricular acceleration is used to calculate a mechanical response interval and the mechanical response interval is compared to a desired mechanical response interval. The AV interval is adjusted until the mechanical response interval is equal to the desired mechanical response interval.

First claim

The invention claimed is:

1. A medical device system for delivering mechanically fused left ventricular cardiac stimulation, said system comprising:
an implantable medical device (IMD);
a plurality of electrical medical leads coupled to the IMD and adapted to deliver left ventricular stimulation to a patient upon expiration of an AV interval; and
at least one sensor capable of monitoring left ventricular motion and providing a left ventricular motion signal to the IMD, the IMD configured to determine a mechanical response interval measured from delivery of the left heart ventricular stimulation based on the left ventricular motion signal, the IMD configured to adjust the AV interval after determining that the mechanical response interval differs from a predetermined desired mechanical response interval in order to deliver mechanically-fused left ventricular cardiac stimulation.

2. A medical device system according to claim 1 , wherein the left ventricular motion signal comprises one of a left ventricular lateral wall acceleration signal and a derivative of the left ventricular lateral wall acceleration signal.

3. A medical device system according to claim 1 , wherein the IMD is configured to determine the mechanical response interval using fiducial points on the left ventricular motion signal to detect aortic valve opening.

4. A medical device system according to claim 3 , wherein the IMD is configured to determine the mechanical response interval by identifying maximum left ventricular motion during a pre-ejection interval to detect aortic valve opening.

5. A medical device system according to claim 4 , wherein the maximum left ventricular motion is identified within a time window and wherein the time window is set based on one of intrinsic and evoked electrical cardiac activity.

6. A medical device system for delivering mechanically fused left ventricular cardiac stimulation, said system comprising:
an implantable medical device (IMD);
a plurality of electrical medical leads coupled to the IMD and adapted to deliver left ventricular stimulation to a patient upon expiration of an AV interval; and
at least one sensor capable of monitoring left ventricular motion and providing a left ventricular motion signal to the IMD, the IMD configured to determine a mechanical response interval measured from delivery of the left heart ventricular stimulation based on the left ventricular motion signal, the IMD configured to adjust the AV interval after determining that the mechanical response interval differs from a predetermined desired mechanical response interval in order to deliver mechanically-fused left ventricular cardiac stimulation;

wherein the maximum left ventricular motion is identified within a time window and wherein the time window is set based on one of intrinsic and evoked electrical cardiac activity; and
wherein the mechanical response interval comprises a pre-ejection interval.

7. A medical device system according to claim 1 , further comprising at least one sensor capable of monitoring a right ventricular pressure (P) coupled to said IMD.

8. A medical device system according to claim 7 , wherein the IMD is configured to detect opening of a pulmonic valve by identifying a maximum right ventricular dP/dt.

9. A medical device system according to claim 8 , wherein the mechanical response interval includes an interventricular delay.

10. A medical device system according to claim 1 , wherein the IMD is configured to compare the mechanical response interval to the desired mechanical response interval and to increase or decrease the AV interval based upon this comparison.

11. A medical device system according to claim 10 , wherein the IMD is configured to increase the AV interval if the mechanical response interval is less than the desired mechanical response interval and is configured to decrease the AV interval if the mechanical response interval is greater than the desired mechanical response interval.

12. A medical device system according to claim 1 , further comprising a sensor for monitoring septal wall acceleration and providing a septal wall acceleration signal to the IMD.

Assignees

• Prakash Rajan
• Sambelashvili Aleksandre T
• Medtronic Inc

Inventors

• Prakash Rajan
• Sambelashvili Aleksandre T

Classifications

• A61N1/36564

  controlled by blood pressure · CPC title

• A61N1/36585 Primary

  controlled by two or more physical parameters · CPC title

• A61N1/3682

  with a variable atrioventricular delay · CPC title

• A61N1/36542

  controlled by body motion, e.g. acceleration · CPC title

• A61N1/3627

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