Method and system for configuration of a pacemaker and for placement of pacemaker electrodes

1. A cardiac ultrasound imaging system for helping a clinician select a pacemaker electrode site and configure a pacemaker, the system comprising:

an intracardiac ultrasound imaging system configured to image a patient's heart; and

a computer configured to:

process images generated by the ultrasound system in order to compute a measurement of cardiac ejection volume for a given pacemaker configuration and electrode site;

save two or more combinations of the corresponding pacemaker configuration, the corresponding electrode site, and the ejection volume measurement;

save a cardiac dysynchrony measurement and an activation voltage for each of the saved combinations;

retrieve the ejection volume measurement, the pacemaker configuration, and the electrode site of any of the save combinations; and

determine a figure-of-merit value for each saved combination by applying a function comprising:

F ( E,D,V )= C E ·E−C D ·D−C V ·V

wherein:

C E , C D , and C V are non-negative coefficients;

E is the saved cardiac ejection volume or ejection fraction computed relative to a maximum cardiac volume;

D is dysynchrony delay time or phase obtained from the saved cardiac dysynchrony measurement; and

V is the saved activation voltage; and

wherein the computer is configured to display a saved combination in conjunction with the determined figure-of-merit value for each of the saved combinations.

2. The system of claim 1 , wherein the computer is configured to display at least one of the saved combinations.

3. The system of claim 1 , wherein the computer is configured to rank the saved combinations according to a specified criterion.

4. The system of claim 3 , wherein the criterion is activation voltage and the combinations are ranked in order from lowest voltage to highest voltage.

5. The system of claim 3 , wherein the criterion is ejection volume and the combinations are ranked in order from most volume to least volume.

6. The system of claim 3 , wherein the criterion is dysynchrony timing delay and the combinations are ranked in order from least delay to most delay.

7. The system of claim 3 , wherein the computer is configured to accept the criterion as an input provided by a user of the system.

8. The system of claim 1 , wherein the computer is configured to associate the electrode site of a saved combination with a site on an image of the heart.

9. The system of claim 1 , wherein the computer is configured to rank the saved combinations in order according to the figure-of-merit value.

10. The system of claim 1 , wherein the computer is configured to accept the function coefficients from a user of the system.

11. A method for helping a clinician to select a pacemaker electrode site and to configure a pacemaker, the method comprising:

positioning a pacemaker electrode at a site on a patient's heart;

configuring the pacemaker with operational parameters;

imagining the patient's heart with an intracardiac ultrasound imaging system;

computing a measure of cardiac ejection volume;

saving in a computer memory a combination of the measure of cardiac ejection volume, the corresponding pacemaker operational parameters including an activation voltage, a dysynchrony measurement, and the corresponding electrode site;

performing the positioning, configuring, imaging, computing, and saving steps for two or more different combinations of electrode site and pacemaker operational parameters;

retrieving from the computer memory the saved measure of cardiac ejection volume, the pacemaker operational parameters, and electrode site of at least one of the saved combinations; and

applying a function to each saved combination to return a figure-of-merit value for the combination, the function returning the figure-of-merit value comprising applying the formula:

F ( E,D,V )= C E ·E−C D ·D−C V ·V

wherein:

C E , C D , and C V are non-negative coefficients;

E is the saved cardiac ejection volume or ejection fraction computed relative to a maximum cardiac volume;

D is dysynchrony delay time or phase obtained from the saved cardiac dysynchrony measurement; and

V is the saved activation voltage; and

displaying at least one of the saved combinations in conjunction with the determined figure-of-merit value for the at least one of the saved combinations.

12. The method of claim 11 , further comprising displaying at least one of the saved combinations.

13. The method of claim 11 , further comprising ranking the saved combinations according to a criterion.

14. The method of claim 13 , wherein the criterion is activation voltage and said ranking comprises ranking the saved combinations in order from lowest voltage to highest voltage.

15. The method of claim 13 , wherein the criterion is ejection volume and said ranking comprises ranking the saved combinations in order from most volume to least volume.

16. The method of claim 13 , wherein the criterion is dysynchrony timing delay and said ranking comprises ranking the saved combinations in order from least delay to most delay.

17. The method of claim 13 , further comprising a user of the method specifying the criterion.

18. The method of claim 11 , further comprising associating the electrode site of a saved combination with a site on an image of the heart.

19. The method of claim 11 , wherein the ranking is performed according to the figure-of-merit value.

20. The method of claim 11 , further comprising saving a baseline combination of the ejection volume measured without stimulation of the patient's heart.

21. The method of claim 11 , further comprising saving notes, markers, and annotations with the saved site, configuration, and measurements.