St. Jude Medical, Cardiology Division, Inc.

Sorin Crm Sas

Pacesetter, Inc.

Ela Medical S.a.s.

Ela Medical S.a.

Cyrille Casset

Chunlan Jiang

Louis-Philippe Richer

Craig Markovitz

Jan O Mangual-Soto

Luke C McSpadden

Kyungmoo Ryu

Yelena Nabutovsky

Fujian Qu

Nima Badie

Jan Mangual

Caroline D Jordan

Melanie Heurteau

Marcel Limousin

Fabrizio Renesto

Mélanie Heurteau

The present disclosure provides systems and methods for optimizing pacing parameters of a cardiac pacing device implanted in a patient. The systems and methods measure a plurality of hemodynamic responses of the patient. Each hemodynamic response is associated with the cardiac pacing device configured with one candidate pacing parameter set of a plurality of candidate pacing parameter sets. Each candidate pacing parameter set is classified as electrically equivalent to a reference pacing parameter set according to a classification criterion. The systems and methods further identify an optimal hemodynamic response from the plurality of hemodynamic responses, and select a final candidate pacing parameter set corresponding to the optimal hemodynamic response.

Systems and methods for normalizing cardiac electrical conditions of measured hemodynamic variations for use in cardiac pacing device optimization processes

A method of generating a map of a portion of a patient's anatomy using an electroanatomical mapping system includes separating an anatomical region (e.g., the heart) into an inclusion region (e.g., the left atrium) and an exclusion region (e.g., the left ventricle) by defining a boundary surface (e.g., along the mitral valve). A label electrode carried by a multi-electrode catheter can be defined and used to determine whether or not to add an electrophysiology data point collected using the multi-electrode catheter to the map. In particular, electrophysiology data points can be added to the map of the portion of the patient's anatomy when they are collected with the label electrode within the inclusion region. Positions of the label electrode can also be used to define the boundary surface. Alerts can also be provided when the label electrode crosses the boundary surface and enters the exclusion region.

System and method for cardiac mapping

When generating anatomical maps (e.g., anatomical geometries and/or electrophysiology maps), it can be desirable to analyze whether or not a collected data point was collected from a region of interest. During an electrophysiology study, for example, an electroanatomical mapping system collects electrophysiology data points, each including an electrogram signal. By defining both a window of interest and a window of exclusion within the electrogram signal, the electroanatomical mapping system can analyze collected data points to determine whether or not they should be included in a map. In particular, the electroanatomical mapping system can compare the electrophysiology signal within the window of interest and the window of exclusion with respect to at least one signal parameter and add the data point to the map if the comparison satisfies at least one corresponding inclusion criterion. Applicable signal parameters include maximum peak-to-peak voltage, conduction velocity, and electrogram morphology.

The signal quality of an electrophysiological signal can be determined from information regarding proximal stability of an electrophysiology catheter at the time the signal is acquired and temporal stability of the electrophysiological signal. The proximal stability information can include a distance between the electrophysiology catheter and an anatomical surface, a velocity of the electrophysiology catheter, and/or contact force between the electrophysiology catheter and the anatomical surface. Graphical representations of signal quality scores can be output to a display in order to enable visualization thereof by a practitioner.

System and method for electrophysiological mapping

Systems and methods for identifying potential ablation sites using electrical parameter data are provided. A method includes geometrically isolating an arrhythmogenic substrate in a three-dimensional geometry. The method further includes generating a first cumulative map from a first dataset including electrical parameter data for each vertex in the isolated arrhythmogenic substrate, and generating a second cumulative map from a second dataset including additional data for each vertex. The method further includes generating a third cumulative map from the first and second cumulative maps, and displaying the third cumulative map on the three-dimensional geometry to facilitate identifying potential ablation sites.

Systems and methods for identifying ablation locations using electrical parameter data

The present disclosure is directed to merging data acquired from differently configured catheters on a common map. In use, physical characteristics of catheters influence recorded electrical signals/responses such that differently configured catheters (e.g., different electrode sizes, shapes, materials, spacings, etc.) may record different responses to measurements taken at the same location in response to the same excitation signal. To allow merging of data from differently configured catheters in a common map, the present disclosure applies a corrective coefficient or transfer function to the recorded electrical signals of one or both catheters to counter-balance variable influences of catheter specific characteristics on recorded signals.

Methods and tools to merge mapping data acquired from multiple catheters

Systems and methods for resolving catheter rendering issues are provided. A system includes a catheter including a plurality of electrodes and a plurality of catheter pins, each catheter pin corresponding to an associated electrode. The system further includes a mapping system communicatively coupled to the catheter, the mapping system including a pin box including a plurality of sockets, a display device configured to render the catheter, and an electronic control unit (ECU). The ECU is configured to determine that the catheter is being rendered incorrectly on the display device, determine a number of electrodes that are being rendered incorrectly on the display device, identify at least one particular electrode of the plurality of electrodes that is being rendered incorrectly on the display device, and attempt to resolve the incorrect rendering of the catheter based on the determined number of electrodes and the at least one particular electrode.

Methods and systems for resolving catheter rendering issues

A method of generating an electrophysiology map of a portion of a patient's anatomy using an electroanatomical mapping system, includes defining a plurality of inclusion criteria, collecting a plurality of electrophysiology data points, each being associated with inclusion data, and identifying those electrophysiology data points that have inclusion data satisfying the inclusion criteria. The inclusion criteria can then be automatically adjusted to drive the number of electrophysiology data points having inclusion data satisfying the inclusion criteria towards a target number. A graphical representation of the electrophysiology map can be rendered using the final set of electrophysiology data points.

System and method for generating electrophysiology maps

Computer implemented methods and systems are provided for automatically determining capture thresholds for an implantable medical device equipped for cardiac stimulus pacing using a multi-pole left ventricular (LV) lead. The methods and systems measures a base capture threshold for a base pacing vector utilizing stimulation pulses varied over at least a portion of an outer test range. The base pacing vector is defined by a first LV electrode provided on the LV lead and a second electrode located remote from an LV chamber. The methods and systems designate a secondary pacing vector that includes the first LV electrode and a neighbor LV electrode provided on the LV lead. The methods and systems further define an inner test range having secondary limits based on the base capture threshold, wherein at least one of the limits for the inner test range differs from a corresponding limit for the outer test range. The methods and systems measure a secondary capture threshold associated with the secondary pacing vector utilizing stimulation pulses varied over at least a portion of the inner test range.

Method and system to determine capture thresholds

The present disclosure provides systems and methods for determining a proposed ablation site in a cardiac chamber. A system includes an implanted device configured to record a plurality of intracardiac electrogram (IEGM) couples, and a mapping and ablation system communicatively coupled to the implanted device. The mapping and ablation system is configured to receive the recorded plurality of IEGM couples from the implanted device, calculate a parameter for each of the plurality of IEGM couples, determine, based on the calculated parameters, an area of origin for each IEGM couple, and determine an intersection between the determined areas of origin, wherein the intersection represents the proposed ablation site in the cardiac chamber.

Systems and methods for leveraging IEGM couples to determine ablation sites

An active implantable medical device for cardiac resynchronization includes implantable electrodes configured to detect atrial and ventricular events and to apply electrical pulses to a plurality of stimulation sites of the right and left ventricles, where a first combination of stimulation sites define an original pacing configuration and a second combination of stimulation sites define a changed pacing configuration. A sensing device is configured to measure a peak to peak amplitude of the first peak of endocardial acceleration for each cardiac cycle. A processing circuit is configured to change the pacing configuration from the original pacing configuration to the changed pacing configuration, measure one of a set of values in the changed pacing configuration, and change the pacing configuration from the changed pacing configuration to the original pacing configuration.

Implantable medical device for resynchronization by biventricular pacing using reverse remodeling

Improving cardiac response in terms of pressure, ejected volume, and filling and ejection times by cardiac reverse remodelling, including temporary, occasionally harmful stimulation sequences. An original pacing configuration () is switched to a modified pacing configuration () in a direction opposite to that of an optimization of the hemodynamic parameters, to cause an immediate change in the response to controlled stimulation of the myocardium. This response is assessed based on: the maximum value (P (b, a)) achieved by the peak-to-peak (PEA (i)) of the first peak of endocardial acceleration (PEA) after a pacing configuration change, the mean PEA value (A (b, a)) after stabilization, the PEA variability (V (b, a)) around this average value, and the duration (T (b, a)) of stabilization after the pacing configuration change.

Implantable cardiac prosthetic for resynchronization by biventricular pacing using reverse remodeling

An active implantable medical device or pacing, resynchronization defibrillation and/or cardioversion, and/or a device for diagnosing patient conditions, having a predictive diagnosis of the patient's status. The device measures a physiologic parameter, notably the minute ventilation; measures a physical parameter, notably the acceleration; discriminates between phases of activity and rest of the patient; and includes a memory containing a plurality of fields selectively updated by statistical processing. These fields are comprising one first set containing data related to the patient's activity phases, and one second set containing data related to the patient's rest phases. The statistical processing is updating in a dissociated manner the first and second sets of fields, selectively as a function of the value taken by the status indicator, and the analysis evaluates at least one clinical status index based upon the data contained in the fields of both first and second sets.

Predictive diagnosis of a patient's status in an active implantable medical device notably for cardiac pacing, resynchronization, defibrillation or cardioversion

An active implantable medical device including circuits for calculating an atrio ventricular delay (AVD) period. The device is able to detect the atrial and ventricular events; calculate an AVD and to start the AVD on detection of a spontaneous or paced atrial event. The device is able to deliver a low energy ventricular stimulation pulse at the expiration of the AVD in the absence of a detected spontaneous ventricular event. To calculate the AVD, the device uses an acceleration sensor to deliver an endocardiac acceleration (EA) signal representative of the movements produced by the contractions of the atrial cavity; and analyzes the EA signal to identify and isolate in the EA signal a component corresponding to the fourth peak of endocardiac acceleration (PEA) associated to the atrial activity, and to calculate the AVD based on a parameter of this component.

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Saint Selve, France

Cyrille Casset