GB2408454A - Pacemaker using inter-ventricle impedance measurements to optimise A-V and V-V delays - Google Patents

Pacemaker using inter-ventricle impedance measurements to optimise A-V and V-V delays Download PDF

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Publication number
GB2408454A
GB2408454A GB0327313A GB0327313A GB2408454A GB 2408454 A GB2408454 A GB 2408454A GB 0327313 A GB0327313 A GB 0327313A GB 0327313 A GB0327313 A GB 0327313A GB 2408454 A GB2408454 A GB 2408454A
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United Kingdom
Prior art keywords
ventricular
inter
generator
delay
impedance
Prior art date
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Withdrawn
Application number
GB0327313A
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GB0327313D0 (en
Inventor
Andrew Docherty
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Individual
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Individual
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Priority to GB0327313A priority Critical patent/GB2408454A/en
Publication of GB0327313D0 publication Critical patent/GB0327313D0/en
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Withdrawn legal-status Critical Current

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3627—Heart stimulators for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
    • A61N1/36843—Bi-ventricular stimulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3682—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions with a variable atrioventricular delay

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  • Health & Medical Sciences (AREA)
  • Cardiology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Radiology & Medical Imaging (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Hospice & Palliative Care (AREA)
  • Biophysics (AREA)
  • Physiology (AREA)
  • Electrotherapy Devices (AREA)

Abstract

Bi-ventricular pacemaker systems have an additional lead which is in contact with the left ventricle. In bi-ventricular pacemakers with defibrillator capabilities, defibrillating coils are typically placed within the right ventricle and often the superior vena-cava. Changes in electrical impedance (electrical resistance) between the pole(s) of the left ventricular lead and the pole(s) and/or coils of the right ventricular lead occur during the cardiac cycle of contraction and relaxation. These change in electrical impedance during the cardiac cycle can be measured. The changes in inter-ventricular impedance may be used to optimise the atrio-ventricular delay and/or the inter-ventricular delay without the need to employ echocardiography. Following implantation of the left ventricular and right ventricular leads and attachment of the permanent pacemaker generator or internal cardiac defibrillator generator, the generator can measure changes in inter-ventricular impedance and periodically alter the atrio-ventricular and or inter-ventricular delay to maintain optimised delays.

Description

Title of Invention
Device Mediated Optimisation of Cardiac Resynchronisation AtrioVentricular and/or Inter-Ventricular Intervals.
Description
Background
Conventional permanent dual chamber cardiac pacemakers usually consist oftwo electrical conducting leads which are attached to a pacemaker generator positioned under the skin. One lead is positioned to be in contact with the right atrium ofthe heart and the other is positioned to be in contact with the right ventricle ofthe heart. Bi-ventricular pacemaker systems have an additional lead which is in contact with the left ventricle. Bi- ventricular pacemakers are indicated for use in patients with impaired left ventricular function and dysynchrony of ventricular contractile function. In bi-ventricular pacemakers with defibrillator capabilities, defibrillating coils are typically placed within the right ventricle and often the superior vena-cava.
Problem The delay between atrial electrical excitation and ventricular excitation and the delay between right ventricular electrical excitation and left ventricular excitation are determined and programmed into the pacemaker generator on an individual basis for each patient. The current methods used require the use of echocardiographic measurements of ventricular function and in particular the use of Doppler echocardiography oftrans-mitral flow. Atrio-ventricular delay is determined by employing the Ritter formula or by an iterative process. Optimisation of inter-ventricular delay may require multiple Doppler measurements at one or more valves. The optimal values for a particular patient can vary with time.
Essential Features.
Changes in electrical impedance (electrical resistance) between the pole(s) ofthe left ventricular lead and the pole(s) and/or coils ofthe right ventricular lead occur during the cardiac cycle of contraction and relaxation. These change in electrical impedance during the cardiac cycle can be measured. The changes in inter-ventricular impedance are used to optimise the atrio-ventricular delay and/or the inter-ventricular delay without the need to employ echocardiography.
Particular Examples.
At the time of implanting the left ventricular lead, changes in electrical impedance between the left ventricular lead and the right ventricular lead can be measured using an external pacemaker generator. The generator is programmed to alter the atrio-ventricular delay and the inter-ventricular delay by an iterative process and uses changes in the inter- ventncular Impedance to determine when optimal delays have been achieved.
Following implantation of the left ventricular and right ventricular leads and attachment of the permanent pacemaker generator or internal cardiac defibrillator generator, the generator can measure changes in inter-ventricular impedance and periodically alter the atro-ventncular and or inter-ventricular delay to maintain optimised delays.

Claims (1)

  1. At the time of implanting the left ventricular lead of a pacemaker device, changes in electrical impedance between the left ventricular lead and the right ventricular lead can be measured using an external pacemaker generator. The generator may be programmed to alter the atrio-ventricular delay and the inter-ventricular delay by an iterative process and uses changes in the inter-ventricular impedance to determine when optimal delays have been achieved.
    Following implantation of the left ventricular and right ventricular leads and attachment of the permanent pacemaker generator or internal cardiac defibrillator generator, the generator can measure changes in inter-ventricular impedance and periodically alter the atrio-ventricular and or inter-ventricular delay to maintain optimised delays.
    Page I
GB0327313A 2003-11-25 2003-11-25 Pacemaker using inter-ventricle impedance measurements to optimise A-V and V-V delays Withdrawn GB2408454A (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
GB0327313A GB2408454A (en) 2003-11-25 2003-11-25 Pacemaker using inter-ventricle impedance measurements to optimise A-V and V-V delays

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
GB0327313A GB2408454A (en) 2003-11-25 2003-11-25 Pacemaker using inter-ventricle impedance measurements to optimise A-V and V-V delays

Publications (2)

Publication Number Publication Date
GB0327313D0 GB0327313D0 (en) 2003-12-24
GB2408454A true GB2408454A (en) 2005-06-01

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Family Applications (1)

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GB0327313A Withdrawn GB2408454A (en) 2003-11-25 2003-11-25 Pacemaker using inter-ventricle impedance measurements to optimise A-V and V-V delays

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GB (1) GB2408454A (en)

Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6070100A (en) * 1997-12-15 2000-05-30 Medtronic Inc. Pacing system for optimizing cardiac output and determining heart condition
US20010031995A1 (en) * 2000-03-07 2001-10-18 Molin Renzo Dal Measurement of intracardiac impedance in a multisite-type, active implantable medical device, in particular a pacemaker, defibrillator and/or cardiovertor
US20020147475A1 (en) * 2001-04-10 2002-10-10 Avram Scheiner Cardiac rhythm management system for hypotension
US20030204212A1 (en) * 2002-04-29 2003-10-30 Burnes John E. Algorithm for the automatic determination of optimal AV and VV intervals

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6070100A (en) * 1997-12-15 2000-05-30 Medtronic Inc. Pacing system for optimizing cardiac output and determining heart condition
US20010031995A1 (en) * 2000-03-07 2001-10-18 Molin Renzo Dal Measurement of intracardiac impedance in a multisite-type, active implantable medical device, in particular a pacemaker, defibrillator and/or cardiovertor
US20020147475A1 (en) * 2001-04-10 2002-10-10 Avram Scheiner Cardiac rhythm management system for hypotension
US20030204212A1 (en) * 2002-04-29 2003-10-30 Burnes John E. Algorithm for the automatic determination of optimal AV and VV intervals

Also Published As

Publication number Publication date
GB0327313D0 (en) 2003-12-24

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