초록 ▼

A pacing system for providing optimal hemodynamic cardiac function for parameters such as contractility (peak left ventricle pressure change during systole or LV+dp/dt), or stroke volume (aortic pulse pressure) using system for calculating atrio-ventricular delays for optimal timing of a ventricular

A pacing system for providing optimal hemodynamic cardiac function for parameters such as contractility (peak left ventricle pressure change during systole or LV+dp/dt), or stroke volume (aortic pulse pressure) using system for calculating atrio-ventricular delays for optimal timing of a ventricular pacing pulse. The system providing an option for near optimal pacing of multiple hemodynamic parameters. The system deriving the proper timing using electrical or mechanical events having a predictable relationship with an optimal ventricular pacing timing signal.

대표청구항 ▼

1. An apparatus, comprising: a programmable pulse generator; and at least one sensor, coupled to the programmable pulse generator, to sense a plurality of cardiac events, wherein the programmable pulse generator is adapted to: measure a first time interval between a first cardiac event and a

1. An apparatus, comprising: a programmable pulse generator; and at least one sensor, coupled to the programmable pulse generator, to sense a plurality of cardiac events, wherein the programmable pulse generator is adapted to: measure a first time interval between a first cardiac event and a second cardiac event that has an approximately constant timing relationship with respect to the first cardiac event and a predictable timing relationship to a delivery of pacing timed for maximizing peak positive left ventricular pressure change during systole (LV+dp/dt); determine a delay time interval referenced to the first cardiac event using a predetermined mapping relationship of the first time interval to an approximately optimal delay time interval for maximizing LV+dp/dt; and transmit pacing pulses using the delay time interval. 2. The apparatus of claim 1, wherein the at least one sensor includes a mechanical sensor adapted to sense mechanical events. 3. The apparatus of claim 2, wherein the mechanical sensor includes a micromonometer. 4. The apparatus of claim 2, wherein the mechanical sensor includes a phonographic sensor. 5. The apparatus of claim 2, wherein the mechanical sensor includes an accelerometer. 6. The apparatus of claim 2, wherein the mechanical sensor includes a doppler recorder. 7. The apparatus of claim 2, wherein the mechanical sensor includes an echo imager. 8. The apparatus of claim 2, wherein the programmable pulse generator calculates the delay time interval including an atrio-ventricular delay (AVDc) for optimizing contractility. 9. The apparatus of claim 8, wherein the programmable pulse generator determines the AVDcusing a model that maps a PY interval to the AVDc,wherein the PY interval represents a time interval between an atrial electrical event (P) and a ventricular mechanical event (Y), and wherein the programmable pulse generator generates or detects P, and the mechanical sensor is adapted to detect Y. 10. The apparatus of claim 9, wherein Y indicates a beginning of ventricular contraction. 11. The apparatus of claim 9, wherein the mechanical sensor includes a pressure transducer to determine Y by measuring ventricular pressure. 12. The apparatus of claim 9, wherein the mechanical sensor includes an echo imager to determine Y by measuring wall motion. 13. The apparatus of claim 9, wherein the mechanical sensor includes an accelerometer to determine Y by sensing an acoustic signal. 14. The apparatus of claim 9, wherein the mechanical sensor includes a phonographic sensor to determine Y by sensing a phonogram. 15. The apparatus of claim 1, wherein the at least one sensor includes an electrical sensor adapted to sense electrical events. 16. The apparatus of claim 15, wherein the programmable pulse generator calculates the delay time interval including an atrio-ventricular delay (AVDc) for optimizing contractility. 17. The apparatus of claim 16, wherein the programmable pulse generator determines the AVDcusing a model that maps a PQ* interval to the AVDc,wherein the PQ* interval represents a time interval between an atrial electrical event (P) and an approximate beginning of a QRS complex (Q*), and wherein the electrical sensor is adapted to detect P and Q*. 18. The apparatus of claim 16, wherein the programmable pulse generator determines the AVDcusing a model that maps a PR interval to the AVDc,wherein the PR interval represents a time interval between an atrial electrical event (P) and an approximate peak of ventricular depolarization (R), and wherein the electrical sensor is adapted to detect P and R.