Cardiac pacing for optimal intra-left ventricular resynchronization
Cardiac pacing to treat ventricle dysynchrony for improved cardiac function is performed as follows. Early paced inter-ventricular asynchrony is determined during ventricular pacing. Baseline inter-ventricular asynchrony is determined without pacing. Average inter-ventricular asynchrony is calculated by averaging the early paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony. Atrio-ventricular delay and ventricular-ventricular delay are adjusted during ventricular pacing to yield the average inter-ventricular asynchrony for optimal intra-left ventricular resynchronization and maximal cardiac function. The elements above can be configured in software contained in an implantable medical device or embodied as a computer software product that includes a medium readable by a processor.
1. A method of cardiac pacing for optimal intra-left ventricular resynchronization, comprising:
determining an early paced inter-ventricular asynchrony during ventricular pacing;
determining a baseline inter-ventricular asynchrony without pacing;
calculating an average inter-ventricular asynchrony by averaging the early paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony; and,
adjusting atrio-ventricular delay and ventricular-ventricular delay during ventricular pacing to yield the average inter-ventricular asynchrony for intra-left ventricular resynchronization.
2. The method as in claim 1 , wherein the average inter-ventricular asynchrony optimizes cardiac function by minimizing intra-left ventricular asynchrony.
3. The method as in claim 1 , wherein the early paced inter-ventricular asynchrony is determined by applying a short atrio-ventricular delay and then measuring an activation delay between the left-ventricle and the right-ventricle.
4. The method as in claim 3 , wherein the short atrio-ventricular delay is less than 50 ms.
5. The method as in claim 1 , wherein the baseline inter-ventricular asynchrony is determined by measuring an activation delay between a left-ventricle and a right-ventricle.
6. The method as in claim 1 , wherein intra-left ventricular resynchronization is optimized automatically by the implantable cardiac device.
7. The method as in claim 1 , wherein paced inter-ventricular asynchrony is determined during ventricular pacing using left ventricular pacing with a short atrio-ventricular delay.
8. The method as in claim 1 , wherein atrio-ventricular delay and ventricular-ventricular delay are adjusted by
adjusting atrio-ventricular delay by an atrio-ventricular delay increment and increasing ventricular-ventricular delay by a ventricular-ventricular delay increment,
measuring an inter-ventricular asynchrony,
comparing the inter-ventricular asynchrony to the average inter-ventricular asynchrony,
adjusting atrio-ventricular delay by an atrio-ventricular delay increment and increasing or decreasing ventricular-ventricular delay by a ventricular-ventricular delay increment, and,
setting the atrio-ventricular delay and ventricular-ventricular delay once the average inter-ventricular asynchrony is reached.
9. The method as in claim 8 , wherein the atrio-ventricular delay increment and the ventricular-ventricular delay increment are less than about 30 ms.
10. The method as in claim 8 , wherein the inter-ventricular asynchrony is sensed using a left-ventricular pacing lead and a right-ventricular pacing lead.
11. The method as in claim 8 , wherein comparing the inter-ventricular asynchrony to the average inter-ventricular asynchrony is performed by minimizing the absolute difference between the inter-ventricular asynchrony and the average inter-ventricular asynchrony.
12. A cardiac pacemaker configured for optimizing intra-left ventricular resynchronization, comprising:
means for determining an early paced inter-ventricular asynchrony during ventricular pacing;
means for determining a baseline inter-ventricular asynchrony without pacing;
means for calculating average inter-ventricular asynchrony by averaging the paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony;
means for adjusting atrio-ventricular delay and ventricle-ventricle delay during ventricular pacing to yield the average inter-ventricular asynchrony for intra-left ventricular resynchronization.
13. A cardiac pacemaker for optimal intra-left ventricular resynchronization, comprising:
a housing having a power supply carried in the housing and a feedthrough;
a controller carried in the housing coupled to the power supply;
memory coupled to the controller;
pacing electronics coupled to the controller and the feedthrough;
sensing electronics coupled to the controller and the feedthrough;
a first electrical lead coupled to the feedthrough and configured for positioning in the right ventricle;
a second electrical lead coupled to the feedthrough and configured for positioning in the left ventricle;
software stored in memory containing instructions including,
a first sequence of instructions when executed by the controller, causes the controller receive an early paced inter-ventricular asynchrony data during ventricular pacing through the first electrical lead and sensing electronics,
a second sequence of instruction when executed by the controller, causes the controller to receive a baseline inter-ventricular asynchrony without pacing data through the first electrical lead, the second electrical lead, and sensing electronics,
a third sequence of instruction when executed by the controller, causes the controller to calculate average inter-ventricular asynchrony by averaging the early paced inter-ventricular asynchrony data and the baseline inter-ventricular asynchrony data, and,
a forth sequence of instruction when executed by the controller, causes the controller to adjust atrio-ventricular delay and ventricular-ventricular delay during ventricular pacing to yield the average inter-ventricular asynchrony for optimal intra-left ventricular resynchronization.
14. A cardiac pacemaker for optimal intra-left ventricular resynchronization, comprising:
a housing having a power supply carried in the housing and a feedthrough;
a controller carried in the housing coupled to the power supply;
memory coupled to the controller;
pacing electronics coupled to the controller and the feedthrough;
sensing electronics coupled to the controller and the feedthrough;
a first electrical lead coupled to the feedthrough and configured for positioning in the right ventricle;
a second electrical lead coupled to the feedthrough and configured for positioning in the left ventricle;
means for determining an early paced inter-ventricular asynchrony during ventricular pacing;
means for determining a baseline inter-ventricular asynchrony without pacing;
means for calculating average inter-ventricular asynchrony by averaging the paced inter-ventricular asynchrony and the baseline inter-ventricular asynchrony; and,
means for adjusting atrio-ventricular delay and ventricle-ventricle delay during ventricular pacing to yield the average inter-ventricular asynchrony for intra-left ventricular resynchronization.
15. A computer software product that includes a medium readable by a processor, the medium having stored thereon instructions for cardiac pacing for optimal intra-left ventricular resynchronization in an implantable cardiac, comprising:
a first sequence of instructions when executed by the controller, causes the controller receive an early paced inter-ventricular asynchrony data during ventricular pacing;
a second sequence of instruction when executed by the controller, causes the controller to receive a baseline inter-ventricular asynchrony without pacing data;
a third sequence of instruction when executed by the controller, causes the controller to calculate average inter-ventricular asynchrony by averaging the early paced inter-ventricular asynchrony data and the baseline inter-ventricular asynchrony data; and,
a forth sequence of instruction when executed by the controller, causes the controller to adjust atrio-ventricular delay and ventricular-ventricular delay during ventricular pacing to yield the average inter-ventricular asynchrony for intra-left ventricular resynchronization.