Physiologically responsive VAD
A ventricular assist device incorporating a rotary pump, such as a rotary impeller pump is implantable in fluid communication with a ventricle and an artery to assist blood flow from the ventricle to the artery. The device includes a pump drive circuit supplying power to the pump, one or more sensors for sensing one or more electrophysiological signals such as electrogram signals in and a signal processing circuit connected to the sensors and the pump drive circuit. The signal processing circuit is operative to detect the sensor signals and control power supplied to the pump from the pump drive circuit so that the pump runs in a pulsatile mode, with a varying speed synchronized with the cardiac cycle. When an arrhythmia is detected, the pump drive circuit may also run the pump in an atrial arrhythmia mode or a ventricular arrhythmia mode different from the normal pulsatile mode.
1. A ventricular assist device comprising:
a rotary pump configured to be implantable in fluid communication with a ventricle and an artery of a subject to assist blood flow from the ventricle to the artery; a pump drive circuit for applying power to the pump;
one or more sensors for sensing one or more electrogram signals in a patient; and
a signal processing circuit in communication with the sensors and the pump drive circuit, the signal processing circuit being operative to receive the electrogram signals from the sensors, and control power supplied to the pump from the pump drive circuit so that in a normal sinus rhythm mode the pump drive circuit varies the power applied to the pump in synchronism with the phases of the cardiac cycle as determined by the electrogram signals, wherein a pattern of variation& of the normal sinus rhythm causes the pump to run with a varying pump speed synchronized with each phase of the cardiac cycle such that the varying pump speed varies in a pattern corresponding to the pattern of variation of the normal sinus rhythm.
2. A ventricular assist device as claimed in claim 1 wherein the pump is a rotary impeller pump.
3. A ventricular assist device as claimed in claim 1 , wherein the signal processing circuit is operative to adjust the varying pump speed responsive to a condition of the subject.
4. A ventricular assist device as claimed in claim 3 , wherein the signal processing circuit is operative to adjust the varying pump speed in accordance with electrogram signals received by the circuit from the sensors.
5. A ventricular assist device as claimed in claim 1 , in which the signal processing circuit is operative to control power supplied to the pump so that the varying pump speed has a fixed phase relationship with the P-wave of the subject's cardiac cycle.
6. A ventricular assist device as claimed in claim 1 , in which the signal processing circuit is operative to control power supplied to the pump so that the varying pump speed has a fixed phase relationship with the R-wave of the subject's cardiac cycle.
7. A ventricular assist device as claimed in claim 6 , wherein the fixed phase relationship of the varying pump speed with the R-wave of the subject's cardiac cycle depends on a moving average cycle time over a number of cardiac cycles.
8. The ventricular assist device of claim 1 , wherein the electrogram signals are received by a unipolar configuration of electrodes.
9. The ventricular assist device of claim 8 , wherein the device is further configured to perform waveform analysis of the electrogram signals received from the unipolar configuration.
10. The ventricular assist device of claim 9 , wherein the electrogram signals are at least one of the P-wave, QRS-complex, and T-wave.
11. A ventricular assist device as claimed in claim 1 , wherein the device further comprises a pacemaker operative to synchronize the left ventricle and right ventricle of a patient's heart.
12. A ventricular assist device as claimed in claim 11 , wherein the pacemaker is further operative to synchronize the left ventricle, right ventricle and a fixed phase relationship of the pump with a portion of the cardiac cycle.
13. A ventricular assist device as claimed in claim 1 , wherein the electrogram signals include left ventricular (LV) and right ventricular (RV) waveforms.
14. A ventricular assist device as claimed in claim 13 , wherein the LV and RV waveforms include at least one bipolar signal.
15. A ventricular assist device as claimed in claim 1 , wherein the varying pump speed is synchronized with the cardiac cycle so that the pump operates at a maximum speed during ventricular systole.
16. A ventricular assist device as claimed in claim 1 , in which the signal processing circuit is operative to control power supplied to the pump so that the timing of the start of increasing pump speed is varied with the timing of the P-R interval.
17. The ventricular assist device of claim 1 , wherein the pump is further configured to operate at a constant speed during the normal sinus rhythm mode.
18. The ventricular assist device of claim 1 , wherein the electrogram signals from the sensors are bipolar electrogram signals.
19. The ventricular assist device of claim 18 , wherein the bipolar electrogram signals are operable to analyze cardiac waveform timing.
20. The ventricular assist device of claim 1 , wherein the normal sinus rhythm mode is a constant flow mode.
21. The ventricular assist device of claim 1 , wherein the device is further configured to be implanted in the subject.
22. The ventricular assist device of claim 1 , wherein the signal processing circuit is further configured to calculate a moving average of the R-R, P-R, QRS and ST intervals of the subject's cardiac cycle.
23. The ventricular assist device of claim 1 , wherein the signal processing circuit is further configured to operate in a phase-locked loop with the intrinsic cardiac cycle of the patient.
24. The ventricular assist device of claim 1 , wherein the pump is further configured to have a pump speed waveform in synchronization with the intrinsic cardiac cycle of the patient.
25. The ventricular assist device of claim 1 , wherein the pump speed has a fixed phase relationship to the R-wave of the patient's cardiac cycle.
26. The ventricular assist device of claim 1 , wherein the device further comprises a pulsatile mode which is asynchronous to the cardiac cycle.
27. The ventricular assist devices of claim 1 , wherein the phases of the cardiac cycle include at least one of the P-wave, QRS complex and T-wave.
28. The ventricular assist device of claim 1 , wherein the sensors further comprise electrodes adapted to be in contact with human tissue.
29. The ventricular assist device of claim 1 , wherein the pump speed has a fixed phase relationship to the QRS complex of the patient's cardiac cycle.
30. A ventricular assist device comprising: a rotary pump configured to be implantable in fluid communication with a ventricle and an artery of a subject to assist blood flow from the ventricle to the artery;
a pump drive circuit for applying power to the pump;
one or more sensors for sensing one or more electrogram signals in a patient;
a signal processing circuit in communication with the sensors and the pump drive circuit, the signal processing circuit being operative to receive the electrogram signals, wherein the signal processing circuit is operative to determine the presence or absence of an arrhythmia based on the electrogram signals from the sensors and to control power supplied to the pump from the pump drive circuit so as to operate the pump in a normal sinus rhythm mode in the absence of an arrhythmia and to operate the pump in at least one modified mode of operation in the presence of an arrhythmia.
31. The ventricular assist device of claim 30 , wherein the circuit is operable to detect an atrial arrhythmia and the at least one modified mode of operation includes at least one atrial arrhythmia mode different from the normal sinus rhythm mode.
32. The ventricular assist device of claim 31 wherein the at least one atrial arrhythmia mode includes a non-pulsatile mode wherein the pump runs in a non-pulsatile manner.
33. The ventricular assist device of claim 31 wherein the at least one atrial arrhythmia mode includes a pulsatile mode.
34. The ventricular assist device of claim 31 , wherein the atrial arrhythmia is atrial tachycardia.
35. The ventricular assist device of claim 31 , wherein the atrial arrhythmia is atrial fibrillation.
36. The ventricular assist device of claim 30 , wherein the circuit is operable to detect a ventricular arrhythmia and the at least one modified mode of operation includes at least a ventricular arrhythmia mode different from the normal sinus rhythm mode.
37. A ventricular assist device as claimed in claim 36 wherein the at least one ventricular arrhythmia mode includes a non-pulsatile mode wherein the pump runs in a non-pulsatile manner.
38. A ventricular assist device as claimed in claim 36 wherein the at least one ventricular arrhythmia mode includes a pulsatile mode wherein the pump runs in a pulsatile manner unsynchronized with the cardiac cycle of the subject.
39. The ventricular assist device of claim 36 , wherein the ventricular arrhythmia is ventricular tachycardia.
40. The ventricular assist device of claim 36 , wherein the ventricular arrhythmia is ventricular fibrillation.
41. A ventricular assist device as claimed in claim 30 wherein the at least one modified mode includes a non-pulsatile mode and wherein the signal processing circuit is operative to control power supplied to the pump so as to vary the speed of the pump in the non-pulsatile mode based on a condition of the subject.
42. A ventricular assist device comprising:
a rotary pump configured to be implantable in fluid communication with a ventricle and an artery of a subject to assist blood flow from the ventricle to the artery;
a pump drive circuit for applying power to the pump; one or more sensors for sensing one or more electrogram signals in a patient;
a signal processing circuit in communication with the sensors and the pump drive circuit, the signal processing circuit being operative to receive the electrogram signals from the sensors, and control power supplied to the pump from the pump drive circuit so that in a normal sinus rhythm mode the pump drive circuit varies the power applied to the pump in synchronism with the cardiac cycle and such variation causes the pump to run with a varying pump speed synchronized with the normal sinus rhythm of the subject so that the pump speeds up and slows down during each cardiac cycle, wherein the pump drive circuit is operative to apply AC power to the pump and to vary the power applied to the pump by varying a frequency of the AC power in synchronism with the cardiac cycle so that the frequency of the AC power increases and decreases during each cardiac cycle.