초록 ▼

Systems and methods for evaluating multiple candidate electrostimulation vectors for use in therapeutic cardiac stimulation are disclosed. The system can include a programmable electrostimulator circuit for delivering electrostimulation to one or more sites of a heart according to multiple candidate

Systems and methods for evaluating multiple candidate electrostimulation vectors for use in therapeutic cardiac stimulation are disclosed. The system can include a programmable electrostimulator circuit for delivering electrostimulation to one or more sites of a heart according to multiple candidate electrostimulation vectors. One or more physiologic sensors can detect resulting physiologic responses to the electrostimulation. A processor circuit can generate categories of indicators including therapy efficacy indicators, battery longevity indicators, or complication indicators using the sensed physiologic responses. The candidate electrostimulation vectors can be ranked according to the categories of indicators in specified orders. The system can include a user interface for displaying the ranked candidate electrostimulation vectors, and allowing the user to select one or more electrostimulation vectors and programming the electrostimulator circuit to deliver therapeutic electrostimulation to at least one site of the heart using the selected electrostimulation vectors.

대표청구항 ▼

1. A system for evaluating a plurality of candidate electrostimulation vectors for use in therapeutic stimulation of a heart, the system comprising: a programmable electrostimulator circuit, powered by a battery, configured to deliver electrostimulation to at least one site of the heart using a spec

1. A system for evaluating a plurality of candidate electrostimulation vectors for use in therapeutic stimulation of a heart, the system comprising: a programmable electrostimulator circuit, powered by a battery, configured to deliver electrostimulation to at least one site of the heart using a specified electrostimulation vector;a physiologic sensor circuit configured to sense one or more physiologic signals;a processor circuit, configured to compute a composite efficacy score using at least two cardiac electrical or mechanical signal metrics generated from the sensed one or more physiologic signals, and to generate at least (1) a cardiac stimulation efficacy indicator using the computed composite stimulation efficiency score and (2) a battery longevity indicator, the cardiac stimulation efficacy indicator including a numerical or categorical value indicating a therapeutic effect of the electrostimulation of the heart using the specified electrostimulation vector, the battery longevity indicator including a numerical or categorical value indicating a battery status when the programmable electrostimulator circuit operates according to the specified electrostimulation vector;an electrostimulation vector assessment circuit, included in or communicatively coupled to the processor circuit, configured to: for the plurality of candidate electrostimulation vectors, receive respective cardiac stimulation efficacy indicators and respective battery longevity indicators; andproduce a rankable set of at least some of the plurality of candidate electrostimulation vectors, the rankable set operatively rankable according to the respective cardiac stimulation efficacy indicators and the respective battery longevity indicators. 2. The system of claim 1, wherein the electrostimulation vector assessment circuit is configured to rank at least some of the plurality of candidate electrostimulation vectors, the ranking including: generating first ranked vectors by ranking the at least some of the plurality of candidate electrostimulation vectors according to a first specified order of first indicators; andgenerating second ranked vectors by ranking at least a portion of the first ranked vectors according to a second specified order of second indicators, the portion of the first ranked vectors having corresponding first indicators meeting a specified condition;wherein the first indicators are one, and the second indicators are the other, of the respective cardiac stimulation efficacy indicators or the respective battery longevity indicators. 3. The system of claim 2, wherein the electrostimulation vector assessment circuit is configured to generate the first ranked vectors according to a descending order of the respective cardiac stimulation efficacy indicators, and to generate the second ranked vectors according to a descending order of the respective battery longevity indicators. 4. The system of claim 1, wherein the processor circuit is further configured to generate a complication indicator indicating non-cardiac activation produced by an electrostimulation using the specified electrostimulation vector to the heart, wherein the electrostimulation vector assessment circuit is further configured to: for the plurality of candidate electrostimulation vectors, receive respective complication indicators; andrank at least some of the plurality of candidate electrostimulation vectors further using the complication indicators. 5. The system of claim 4, wherein the respective complication indicators respectively include information about phrenic nerve activation, the information including at least one of presence or absence of phrenic nerve activation, a phrenic nerve stimulation threshold (PNST) indicative of minimum electrostimulation intensity sufficient to elicit phrenic nerve activation, or a safety margin indicative of a relationship between the PNST and a cardiac capture threshold. 6. The system of claim 5, wherein the electrostimulation vector assessment circuit is configured to rank at least some the plurality of candidate electrostimulation vectors, the ranking including: generating first ranked vectors by ranking the at least some of the plurality of candidate electrostimulation vectors according to a first specified order of first indicators;generating second ranked vectors by ranking at least a portion of the first ranked vectors according to a second specified order of second indicators, the portion of the first ranked vectors having corresponding first indicators meeting a specified condition; andgenerating third ranked vectors by ranking at least a portion of the second ranked vectors according to a third specified order of third indicators, the portion of the second ranked vectors having corresponding second indicators meeting a specified condition;wherein the first, second, and third indicators are mutually different ones of the respective cardiac stimulation efficacy indicators, the respective battery longevity indicators, and the respective complication indicators. 7. The system of claim 1, further comprising a user interface unit configured to: display the ranked electrostimulation vectors, the corresponding respective cardiac stimulation efficacy indicators, and the corresponding battery longevity indicators; andreceive a user input, including selecting at least one electrostimulation vector from the ranked electrostimulation vectors and programming the programmable electrostimulator circuit to deliver electrostimulation to the heart using the selected at least one electrostimulation vector. 8. The system of claim 1, comprising one or more left ventricle (LV) electrodes removably and respectively positionable at an LV of the heart, wherein the programmable electrostimulator circuit is configured to be electrically coupled to the one or more LV electrodes and configured to deliver LV electrostimulation using a specified LV electrostimulation vector involving at least one of the LV electrodes. 9. The system of claim 8, wherein the plurality of candidate electrostimulation vectors include two or more unipolar LV electrostimulation vectors and two or more bipolar LV electrostimulation vectors, and the electrostimulation vector assessment circuit is configured to: rank the two or more unipolar LV electrostimulation vectors using first cardiac stimulation efficacy indicators and first battery longevity indicators in response to LV electrostimulation using the two or more unipolar LV electrostimulation vectors;select, automatically or based on a user input, one or more unipolar LV electrostimulation vectors from the ranked unipolar LV electrostimulation vectors;identify, from the two or more bipolar LV electrostimulation vectors, bipolar LV electrostimulation vectors each involving at least one electrode used by the selected unipolar LV electrostimulation vectors; andrank the identified bipolar LV electrostimulation vectors using second cardiac stimulation efficacy indicators and second battery longevity indicators in response to LV electrostimulation using the identified bipolar LV electrostimulation vectors. 10. The system of claim 8, wherein: the electrostimulation vector assessment circuit is configured to select from the ranked LV electrostimulation vectors, automatically or based on a user input, at least first and second LV electrostimulation vectors, and;the programmable electrostimulator circuit is configured to, during the same cardiac cycle, deliver a first LV electrostimulation using the first selected LV electrostimulation vector and deliver a second LV electrostimulation using the second selected LV electrostimulation vector. 11. The system of claim 1, wherein: the physiologic sensor circuit is configured to sense at least a cardiac electrical signal and a cardiac mechanical signal in response to the electrostimulation of the one or more sites of the heart according a specified electrostimulation vector; andthe processor circuit is configured to generate one or more electrical signal metrics and one or more mechanical signal metrics using the cardiac electrical signal and the cardiac mechanical signal, and generate the cardiac stimulation efficacy indicator using the one or more electrical signal metrics and the one or more mechanical signal metrics. 12. The system of claim 1, wherein the processor circuit is configured to generate the battery longevity indicator using one or more of cardiac capture threshold, electrostimulation intensity, electrostimulation waveform, lead impedance, or number of electrodes involved in the specified electrostimulation vector. 13. A method for evaluating a plurality of candidate electrostimulation vectors for use in therapeutic stimulation of a heart, comprising: delivering respective electrostimulation to at least one site of the heart using the plurality of candidate electrostimulation vectors;sensing respective one or more physiologic signals in response to the delivery of the respective electrostimulation;computing respective composite efficacy scores using at least two cardiac electrical or mechanical signal metrics generated from the sensed respective one or more physiologic signals;generating (1) respective cardiac stimulation efficacy indicators using the computed respective composite efficacy scores and (2) respective battery longevity indicators, the respective cardiac stimulation efficacy indicators each including a numerical or categorical value indicating a therapeutic effect of the respective electrostimulation of the heart, the respective battery longevity indicators each including a numerical or categorical value indicating a battery status when the programmable electrostimulator circuit respectively operates according to one of the plurality of electrostimulation vectors;ranking at least some of the plurality of candidate electrostimulation vectors using the respective cardiac stimulation efficacy indicators and the respective battery longevity indicators. 14. The method of claim 13, wherein ranking at least some of the plurality of candidate electrostimulation vectors includes: generating first ranked vectors by ranking the at least some of the plurality of candidate electrostimulation vectors according to a first specified order of first indicators; andgenerating second ranked vectors by ranking at least a portion of the first ranked vectors according to a second specified order of second indicators, the portion of the first ranked vectors having corresponding first indicators meeting a specified condition;wherein the first indicators are one, and the second indicators being the other, of the respective cardiac stimulation efficacy indicators or the respective battery longevity indicators. 15. The method of claim 14, wherein ranking at least some of the plurality of candidate electrostimulation vectors includes generating the first ranked vectors according to a descending order of the respective cardiac stimulation efficacy indicators, and generating the second ranked vectors according to a descending order of the respective battery longevity indicators. 16. The method of claim 14, further comprising, in response to the electrostimulation respectively delivered using the plurality of candidate electrostimulation vectors, generating respective complication indicators each indicating non-cardiac activation produced by the electrostimulation, wherein ranking the candidate electrostimulation vectors includes ranking at least some of the plurality of candidate electrostimulation vectors further using the respective complication indicators, wherein the respective complication indicators respectively include information about phrenic nerve activation, the information including at least one of presence or absence of phrenic nerve activation, a phrenic nerve stimulation threshold (PNST) indicative of minimum electrostimulation intensity sufficient to elicit phrenic nerve activation, or a safety margin indicative of a relationship between the PNST and a cardiac capture threshold. 17. The method of claim 16, wherein ranking the candidate electrostimulation vectors includes: generating first ranked vectors by ranking the at least some of the plurality of candidate electrostimulation vectors according to a first specified order of first indicators;generating second ranked vectors by ranking at least a portion of the first ranked vectors according to a second specified order of second indicators, the portion of the first ranked vectors having corresponding first indicators meeting a specified condition; andgenerating third ranked vectors by ranking at least a portion of the second ranked vectors according to a third specified order of third indicators, the portion of the second ranked vectors having corresponding second indicators meeting a specified condition;wherein the first, second, and third indicators are mutually different ones of the respective cardiac stimulation efficacy indicators, the respective battery longevity indicators, and the respective complication indicators. 18. The method of claim 13, further comprising: displaying in a user interface unit the ranked electrostimulation vectors, the corresponding respective cardiac stimulation efficacy indicators, and the corresponding respective battery longevity indicators;selecting, automatically or based on a user input, at least one electrostimulation vector from the ranked electrostimulation vectors; anddelivering electrostimulation to the heart using the selected at least one electrostimulation vector. 19. The method of claim 13, wherein delivering the electrostimulation includes delivering left ventricular (LV) pacing pulses to one or more LV sites using a plurality of candidate LV electrostimulation vectors including two or more unipolar LV electrostimulation vectors and two or more bipolar LV electrostimulation vectors, wherein ranking the plurality of candidate electrostimulation vectors includes: ranking the two or more unipolar LV electrostimulation vectors using first cardiac stimulation efficacy indicators and first battery longevity indicators in response to LV electrostimulation using the two or more unipolar LV electrostimulation vectors;selecting, automatically or based on a user input, one or more unipolar LV electrostimulation vectors from the ranked unipolar LV electrostimulation vectors;identifying, from the two or more bipolar LV electrostimulation vectors, bipolar LV electrostimulation vectors each involving at least one electrode used by the selected unipolar LV electrostimulation vectors; andranking the identified bipolar LV electrostimulation vectors using second cardiac stimulation efficacy indicators and second battery longevity indicators in response to LV electrostimulation using the identified bipolar LV electrostimulation vectors. 20. The method of claim 13, wherein: generating the respective cardiac stimulation efficacy indicators includes generating one or more electrical signal metrics and one or more mechanical signal metrics, and generating the cardiac stimulation efficacy indicator using a linear or nonlinear combination of at least some of the one or more electrical signal metrics and the one or more mechanical signal metrics; andgenerating the respective battery longevity indicators includes generating the respective battery longevity indicators using one or more of cardiac capture threshold, electrostimulation intensity, electrostimulation waveform, lead impedance, or number of electrodes involved in the specified electrostimulation vector.