Methods and Apparatus for Enhancing Cardiac Pacing

Abstract

Methods, apparatus and systems for enhancing cardiac pacing generally provide for measuring at least one cardiac characteristic, calculating at least one cardiac performance parameter based on the measured characteristic(s), and adjusting at least one functional parameter of a cardiac pacing device. Devices may include at least one catheter (such as a multiplexed catheter with one or more sensors and/or actuators), at least one implant (such as a sensor implantable in a heart wall), or a combination of both. Various cardiac performance parameters and/or pacing device performance parameters may be weighted, and the parameters and their respective weights may be used to determine one or more adjustments to be made to the pacing device. In some instances, the adjustments are made automatically.

1 - 100 . (canceled) 
     
     
         101 . A processor, wherein the processor is configured to:
 be coupled to a cardiac pacing device;   calculate at least one cardiac performance parameter based on at least one characteristic of a heart; and   determine at least one adjustment to be made to at least one functional parameter of the cardiac pacing device based on the at least one cardiac performance parameter.   
     
     
         102 . The processor according to  claim 101 , wherein the at least one functional parameter of the cardiac pacing device comprises a pulse width, a pulse amplitude, a pulse duration, a number of pulses per one cycle of the heart, a pulse polarity, a pulse duty cycle, or a timing of pulses relative to a cycle of the heart. 
     
     
         103 . The processor according to  claim 101 , wherein the at least one cardiac performance parameter comprises ejection fraction, cardiac output, cardiac index, stroke volume, stroke volume index, pressure reserve, volume reserve, cardiac reserve, cardiac reserve index, stroke reserve index, myocardial work, myocardial work index, myocardial reserve, myocardial reserve index, stroke work, stroke work index, stroke work reserve, stroke work reserve index, systolic ejection period, stroke power, stroke power reserve, stroke power reserve index, myocardial power, myocardial power index, myocardial power reserve, myocardial power reserve index, myocardial power requirement, dP/dt, d 2 P/dt, ejection contractility, cardiac efficiency, cardiac amplification, valvular gradient, valvular gradient reserve, valvular area, valvular area reserve, valvular regurgitation, or valvular regurgitation reserve. 
     
     
         104 . The processor according to  claim 101 , wherein the processor is configured to receive at least one cardiac pacing device performance parameter from a cardiac pacing device and calculate the at least one adjustment further based on the at least one cardiac pacing device performance parameter. 
     
     
         105 . The processor according to  claim 104 , wherein the at least one cardiac pacing device performance parameter comprises an energy consumption rate, a maximum current, or a maximum voltage of the cardiac pacing device. 
     
     
         106 . The processor according to  claim 101 , wherein the processor is configured to automatically adjust at least one functional parameter of a cardiac pacing device. 
     
     
         107 . The processor according to  claim 101 , wherein the processor is configured to wirelessly transmit the at least one adjustment to a cardiac pacing device. 
     
     
         108 . The processor according to  claim 101 , wherein the processor is configured to transmit the at least one cardiac performance parameter to a display device. 
     
     
         109 . The processor according to  claim 101 , wherein the processor is further configured to accept at least one command assigning a relative weight to each of the at least one cardiac performance parameter. 
     
     
         110 . The processor according to  claim 109 , wherein the at least one adjustment is further determined based on the relative weight. 
     
     
         111 . The processor according to  claim 109 , wherein the processor is configured to use the at least one command to perform at least one of: selecting the at least one cardiac performance parameter; selecting at least one cardiac pacing device performance parameter; and assigning an additional relative weight to each of the at least one cardiac pacing device performance parameter. 
     
     
         112 . An apparatus for enhancing a cardiac pacing device, the apparatus comprising:
 at least one measuring device to measure at least one characteristic of a heart; and   a processor coupled with the at least one measuring device, wherein the processor is configured to calculate at least one cardiac performance parameter based on the at least one characteristic of the heart and determine at least one adjustment to be made to at least one functional parameter of a cardiac pacing device based on the at least one cardiac performance parameter.   
     
     
         113 . The apparatus according to  claim 112 , wherein the at least one functional parameter of the cardiac pacing device comprises a pulse width, a pulse amplitude, a pulse duration, a number of pulses per one cycle of the heart, a pulse polarity, a pulse duty cycle, or a timing of pulses relative to a cycle of the heart. 
     
     
         114 . The apparatus according to  claim 112 , wherein the at least one measuring device comprises at least one sensor implantable within at least one wall of the heart or at least one catheter positionable within at least one chamber of the heart. 
     
     
         115 . The apparatus according to  claim 114 , wherein the at least one sensor comprises a pressure sensor, a volume sensor, a dimension sensor, a temperature sensor, a thermal sensor, an oxygen sensor, a carbon dioxide sensor, an electrical conductivity sensor, an electrical potential sensor, a pH sensor, a chemical sensor, a flow rate sensor, an optical sensor, an acoustic sensor, a hematocrit sensor, or a viscosity sensor. 
     
     
         116 . The apparatus according to  claim 114 , wherein the at least one catheter comprises at least one multiplexed catheter. 
     
     
         117 . The apparatus according to  claim 116 , wherein the at least one multiplexed catheter comprises an actuator configured to perform at least one of:
 providing an electrical current or voltage; setting an electrical potential; generating a biopotential; pacing a heart; heating a substance or area; inducing a pressure change; releasing or capturing a material; emitting light; emitting sonic or ultrasound energy; and emitting radiation.   
     
     
         118 . The apparatus according to  claim 112 , wherein the at least one cardiac performance parameter comprises ejection fraction, cardiac output, cardiac index, stroke volume, stroke volume index, pressure reserve, volume reserve, cardiac reserve, cardiac reserve index, stroke reserve index, myocardial work, myocardial work index, myocardial reserve, myocardial reserve index, stroke work, stroke work index, stroke work reserve, stroke work reserve index, systolic ejection period, stroke power, stroke power reserve, stroke power reserve index, myocardial power, myocardial power index, myocardial power reserve, myocardial power reserve index, myocardial power requirement, dP/dt, d 2 P/dt, ejection contractility, cardiac efficiency, cardiac amplification, valvular gradient, valvular gradient reserve, valvular area, valvular area reserve, valvular regurgitation, or valvular regurgitation reserve. 
     
     
         119 . The apparatus according to  claim 112 , wherein the processor is configured to receive at least one cardiac pacing device performance parameter from a cardiac pacing device and determine the at least one adjustment further based on the at least one cardiac pacing device performance parameter. 
     
     
         120 . The apparatus according to  claim 119 , wherein the at least one cardiac pacing device performance parameter comprises an energy consumption rate, a maximum current, or a maximum voltage of the cardiac pacing device. 
     
     
         121 . The apparatus according to  claim 112 , wherein the processor is coupled with the cardiac pacing device and is configured to automatically adjust the at least one functional parameter of the cardiac pacing device. 
     
     
         122 . A system for enhancing cardiac pacing, the system comprising:
 a cardiac pacing device;   at least one measuring device to measure at least one characteristic of a heart; and   a processor coupled with the at least one measuring device and the cardiac pacing device, wherein the processor is configured to calculate at least one cardiac performance parameter based on the at least one characteristic of the heart and determine at least one adjustment to be made to at least one functional parameter of the cardiac pacing device based on the at least one cardiac performance parameter.   
     
     
         123 . The system according to  claim 122 , wherein the cardiac pacing device comprises at least one pacing lead. 
     
     
         124 . The system according to  claim 122 , wherein the at least one measuring device comprises at least one sensor implantable within at least one wall of the heart or at least one catheter positionable within at least one chamber of the heart. 
     
     
         125 . The system according to  claim 122 , wherein the at least one cardiac performance parameter comprises ejection fraction, cardiac output, cardiac index, stroke volume, stroke volume index, pressure reserve, volume reserve, cardiac reserve, cardiac reserve index, stroke reserve index, myocardial work, myocardial work index, myocardial reserve, myocardial reserve index, stroke work, stroke work index, stroke work reserve, stroke work reserve index, systolic ejection period, stroke power, stroke power reserve, stroke power reserve index, myocardial power, myocardial power index, myocardial power reserve, myocardial power reserve index, myocardial power requirement, dP/dt, d 2 P/dt, ejection contractility, cardiac efficiency, cardiac amplification, valvular gradient, valvular gradient reserve, valvular area, valvular area reserve, valvular regurgitation, or valvular regurgitation reserve. 
     
     
         126 . The system according to  claim 122 , wherein the processor is configured to receive at least one cardiac pacing device performance parameter from the cardiac pacing device and determine the at least one adjustment further based on the at least one cardiac pacing device performance parameter.