Determination of cardiac resynchronization therapy settings

摘要

CRT settings for an implantable medical device are determined by applying pacing pulses to heart chambers of a scheme of different combinations of interchamber delays. A respective width parameter value representing an R or P wave width is determined for each such delay combination based on an ECG representing signal and the width parameter values are employed to estimate a parametric model defining the width parameter as a function of interchamber delays. Candidate interchamber delays that minimize the width parameter are determined from the parametric model and employed to determine optimal CRT settings. The technique provides an efficient way of finding optimal CRT settings when multiple pacing sites are available in a heart chamber.

主权项

1. A system for determining cardiac resynchronization therapy settings, said system comprising:
an electrode connector connectable to a first electrode configured to be arranged in connection with a first chamber of a heart of a subject and N≧2 electrodes configured to be arranged in connection with a second chamber of the heart; a pulse generator connected to the electrode connector and configured to generate pacing pulses to be applied to the first electrode and the N electrodes; a pulse generator controller connected to the pulse generator and configured to control the pulse generator to generate the pacing pulses to be applied to the first electrode and the N electrodes of a defined scheme of interchamber delays defining, for each electrode of the N electrodes, a maximum interchamber delay, a minimum interchamber delay and an intermediate interchamber delay with regard to the timing of applying a pacing pulse to the first electrode; a width processor configured to determine, for each combination of N interchamber delays of the defined scheme, a width parameter value representative of a width of a resulting R wave, if the first and second chambers are first and second ventricles, or of a resulting P wave, if the first and second chambers are first and second atria, occurring in an electrocardiogram representing signal recorded for the heart; a model processor configured to estimate, based on the width parameter values, an nth order parametric model defining the width parameter as a function of a respective interchamber delay for each electrode of the N electrodes, n≧2; a delay processor configured to determine, based on the nth order parametric model and for each electrode of the N electrodes, a candidate interchamber delay that minimizes the width parameter; and a memory configured to store cardiac resynchronization settings obtained based on the N candidate interchamber delays.