Source: http://www.google.com/patents/US6915149?dq=6101531
Timestamp: 2016-08-24 07:32:01
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Matched Legal Cases: ['art 20', 'art 20', 'art 20', 'art 20', 'art 20', 'art 20']

Patent US6915149 - Method of pacing a heart using implantable device - Google PatentsSearch Images Maps Play YouTube News Gmail Drive More »Sign inPatentsA method of determining an optimal location for implanting a pacemaker electrode includes the steps of pacing a heart from a first location and generating a first map of the heart associated with pacing at the first location. The heart is paced from a second location and a second map is generated of...http://www.google.com/patents/US6915149?utm_source=gb-gplus-sharePatent US6915149 - Method of pacing a heart using implantable deviceAdvanced Patent SearchPublication numberUS6915149 B2Publication typeGrantApplication numberUS 10/043,663Publication dateJul 5, 2005Filing dateJan 11, 2002Priority dateJan 8, 1996Fee statusPaidAlso published asUS20020087089Publication number043663, 10043663, US 6915149 B2, US 6915149B2, US-B2-6915149, US6915149 B2, US6915149B2InventorsShlomo Ben-HaimOriginal AssigneeBiosense, Inc.Export CitationBiBTeX, EndNote, RefManPatent Citations (42), Referenced by (84), Classifications (41), Legal Events (4) External Links: USPTO, USPTO Assignment, EspacenetMethod of pacing a heart using implantable device
US 6915149 B2Abstract
A method of determining an optimal location for implanting a pacemaker electrode includes the steps of pacing a heart from a first location and generating a first map of the heart associated with pacing at the first location. The heart is paced from a second location and a second map is generated of the heart associated with pacing at the second location. The first and second maps are compared in order to diagnose the effect of the pacing and an optimal location for implanting the pacemaker electrode based on the comparison of the maps is selected.
Cardiovascular diseases accounted for approximately 43 percent of the mortality in the United States of America in 1991 (923,000 persons). However, many of these deaths are not directly caused by an acute myocardial infraction (AMI). Rather, many patients suffer a general decline in their cardiac output known as heart failure. Once the overt signs of heart failure appear, half the patients die within five years. It is estimated that between two and three million Americans suffer from heart failure and an estimated 200,000 new cases appear every year. In many cases heart failure is caused by damage accumulated in the patient's heart, such as damage caused by disease, chronic and acute ischemia and especially (˜75%) as a result of hypertension.
Lameh Fananapazir, Neal D. Epstein, Rodolfo V. Curiel, Julio A. Panza, Dorothy Tripodi and Dorothea McAreavey, in “Long-Term Results Of Dual-Chamber (DDD) Pacing In Obstructive Hypertrophic Cardiomyopathy”, Circulation, Vol. 90, No. 60, pp. 2731-2742, December 1994, the disclosure of which is incorporated herein by reference, describes the effects of pacing a HCM-diseased heart using DDD pacing at the apex of the right ventricle. One effect is that the muscle mass near the pacing location is reduced, i.e., the ventricular septum is atrophied. The atrophy is hypothesized to be caused by the changes in workload at the paced location which are due to the late activation time of ventricular segments far from the pacing location.
Margarete Hochleitner, Helmut Hortnagl, Heide Hortnagl, Leo Fridrich and Franz Gschnitzer, in “Long-Term Efficiency Of physiologic Dual-Chamber pacing In The Treatment Of End-Stage Idiopathic Dilated Cardiomyopathy”, American Journal of Cardiology, volume 70, pp. 1320-1325, 1992, the disclosure of which is incorporated herein by reference, describes the effect of DDD pacing on hearts which are dilated as a result of idiopathic dilated cardiomyopathy. DDD pacing resulted in an improvement of cardiac function and in a reduction in hypertrophy in several patients. In addition, it is suggested that positioning the ventricular electrode of the DDD pacemaker in near the apex of the right ventricle reduced the stress at the apex of the left ventricle, by its early activation. No method is suggested for choosing the implantation location of the electrodes.
Xavier Jeanrenaud, Jean-Jacques Goy and Lukas Kappenberger, in “Effects Of Dual Chamber Pacing In Hypertrophic Obstructive Cardiomyopathy”, The Lancet, Vol. 339, pp. 1318-1322, May 30, 1992, the disclosure of which is incorporated herein by reference, teaches that to ensure success of DDD pacing in HCM diseased hearts, an optimum AV interval (between atrial activation and ventricular activation) is required. In addition, it is suggested that this optimal AV interval is modified by performing exercise.
“Biomedical Engineering Handbook”, ed. Joseph D. Bronzino, chapter 156.3, pp. 2371-2373, IEEE press/CRC press, 1995, describes modeling strategies in cardiac physiology. On page 2373 a model is described, including experimental support, according to which model the shape of a ventricle is determined by the (local) amount of oxygen consumption. In addition, this model differentiates between pressure overload on the heart, which causes thickening of muscle fibers, denoted concentric hypertrophy, and volume overload which causes an increase in the ventricular volume (by stretching), denoted eccentric hypertrophy. Eccentric hypertrophy may also be caused by reducing the amount of oxygen available to the cardiac muscle.
R. S. Reneman, F. W. prinzen, E. C. Cheriex, T. Arts and T. Delhass, in “Asymmetrical Changes in Left Ventricular Diastolic Wall Thickness Induced by Chronic Asynchronous Electrical Activation in Man and Dogs”, FASEB J., 1993; 7; A752 (abstract), abstract number 4341, the disclosure of which in incorporated herein by reference, describe results of studies in paced hearts and which show that earlier activated ventricular wall portions were thinner than later activated wall portions, showing an asymmetrical hypertrophy as a result of the pacing.
C. Daubert, P H. Mabo, Veronique Berder, D. Gras and C. LeClercq, in “Atrial Tachyarrhythmias Associated with High Degree Interatrial Conduction Block: Prevention by Permanent Atrial Resynchronisation”, European Journal of C.P.E, Vol. 4, No. 1, pp. 35-44, 1994, the disclosure of which is incorporated herein by reference, describes a method of treating atrial fibrillation by implanting pacemaker electrodes in various locations in the heart, including two electrodes in the right atrium.
Frits W. Prinzen, Cornelis H. Augustijn, Theo Arts, Maurits A. Allessie and Robert Reneman, in “Redistribution of Myocardial Fiber Strain and Blood Flow by Asynchronous Activation”, American Journal of Physiology No. 259 (Heart Circulation Physiology No. 28), H300-H308, 1990, the disclosure of which is incorporated herein by reference, describes studies which show that the location of pacing electrodes in a paced heart significantly affect the distribution of strain, and perfusion (blood flow) in the heart.
When used herein, the terms “physiological variable” and “cardiac parameter” do not include electrical activity, rate, arrhythmia or sequencing of the heart. The term “local physiological value” does not include electrical activity, per se, rather it refers to a local physiological state, such as contraction of local heart muscle, perfusion or thickness. The term “location” refers to a location on or in an object, such as the heart muscle. For example, a valve or an apex of the heart. “Position” refers to a position in space, usually relative to a known portion of the heart, for example, 1.5 inches perpendicular from the apex of the heart.
The term “local information” includes any information associated with the location on the heart wall, including position and electrical activity.
Referring to FIG. 6, a distal tip 74 of a mapping catheter 72 is inserted into heart 20 and brought into contact with heart 20 at a location 75. Preferably, the position of tip 74 is determined using a position sensor 76. Sensor 76 is preferably a position sensor as described in PCT application US95/01103, “Medical diagnosis, treatment and imaging systems”, filed Jan. 24, 1995, in U.S. Pat. No. 5,391,199 or in U.S. Pat. No. 5,443,489, all assigned to the same assignee as the instant application and the disclosures of which are incorporated herein by reference, and which typically require an external magnetic field generator 73. Alternatively, other position sensors as known in the art are used, for example, ultrasonic, RF and rotating magnetic field sensors. Alternatively or additionally, tip 74 is marked with a marker whose position can be determined from outside of heart 20, for example, a radio-opaque marker for use with a fluoroscope. Preferably, at least one reference catheter 78 is inserted into heart 20 and placed in a fixed position relative to heart 20. By comparing the positions of catheter 72 and catheter 78, the position of tip 74 relative to the heart can be accurately determined even if heart 20 exhibits overall motion within the chest. Preferably the positions are compared at least once every cardiac cycle, more preferably, during diastole. Alternatively, position sensor 76 determines the position of tip 74 relative to catheter 78, for example, using ultrasound, so no external sensor or generator 73 is required. Alternatively, catheter 78 is outside the heart, such as outside the body or in the esophagus.
Alternatively or additionally, a perfusion meter is mounted on tip 74 to determine the amount of perfusion. Examples of perfusion meters include: a Doppler ultrasound perfusion meter or a Doppler laser perfusion meter, such as disclosed in “Design for an ultrasound-based instrument for measurement of tissue blood flow”, by Bums, S. M. and Reid, M. H., in Biomaterials. Artificial Cells and Artificial Organs, Volume 17, Issue 1 page 61-68, 1989, the disclosure of which is incorporated herein by reference. Such a perfusion meter preferably indicates the flow volume and/or the flow velocity.
Cardiac mapping in accordance with preferred embodiments of the invention, is preferably performed using the Carto system (for electrical mapping) and the Noga system (for electromechanical mapping), both available form Biosense (Israel) Ltd., Tirat HaCarmel, Israel. Some preferred types of mapping catheters are described in a PCT application filed in Israel on Jan. 8, 1997, by applicant “Biosense” and titled “Mapping Catheter”, the disclosure of which is incorporated herein by reference.
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examinerClassifications U.S. Classification600/374, 600/508International ClassificationA61N1/362, A61N1/368, A61B5/06, A61N1/32, A61B18/20, A61B5/042, A61B5/029, A61B5/0215, A61N1/365, A61B5/00, A61B17/00Cooperative ClassificationA61B5/0422, A61B18/20, A61N1/36564, A61B5/06, A61N1/3627, A61M2025/0166, A61B5/145, A61B2018/00392, A61B5/6859, A61N1/368, A61B5/029, A61B2017/00247, A61B5/0215, A61B5/02014, A61B5/6843, A61N1/32European ClassificationA61B5/145, A61B5/68B5, A61B5/68D1H6, A61B5/02D2, A61B5/0215, A61B5/029, A61N1/365B9, A61N1/32, A61B5/042D, A61B5/06, A61N1/362C, A61B18/20Legal EventsDateCodeEventDescriptionJan 13, 2009REMIMaintenance fee reminder mailedApr 1, 2009SULPSurcharge for late paymentApr 1, 2009FPAYFee paymentYear of fee payment: 4Dec 5, 2012FPAYFee paymentYear of fee payment: 8RotateOriginal ImageGoogle Home - Sitemap - USPTO Bulk Downloads - Privacy Policy - Terms of Service - About Google Patents - Send FeedbackData provided by IFI CLAIMS Patent Services