Sorin Crm Sas

Ela Medical S.a.s.

Université De Bretagne Occidentale

Centre Hospitalier RÉgional Et Universitaire De Brest

Ela Medical S.a.

Fabrizio Renesto

Filippo Ziglio

Lionel Giorgis

Christine Henry

Cyrille Casset

Amel Amblard

Gianni Plicchi

Emanuela Marcelli

Jérôme Dumont

Jacques Mansourati

A medical device for stimulating the heart using biventricular stimulation. The device includes a sensor for detecting an endocardial acceleration parameter and a processing circuit configured to receive the endocardial acceleration parameter. The device further includes stimulation electronics coupled to the processing circuit. The processing circuit is configured to use the EA parameter to evaluate the biventricular stimulation. The evaluation includes comparing the value of the EA parameter in biventricular mode to the value of the EA parameter in left only mode or right only mode, and using the comparison and an assessment of the variability of the EA parameter as a function of the AVD in the left or right mode to distinguish between cases comprising: (a) normal operation, (b) a loss of RV or LV capture, (c) possible anodal stimulation. The processing circuit is further configured to conduct at least one update to operational parameters of the device based on the determined case.

Implantable cardiac resynchronizer with biventricular pacing and detection of loss of capture and anodal stimulation

The invention relates to an active implantable pacemaker. The device analyzes a ventricular electrogram signal (EGM) and is able to recognize, in a search window, an EA4 component of endocardial acceleration (EA) associated with atrial activity. In the presence of atrioventricular conduction, the search window is determined based on the temporal position of the EA1 and/or EA2 components of the EA signal. In the absence of atrioventricular conduction, a delay is counted from a paced ventricular event and applied to mask the EA1 and/or EA2 components in the EA signal, and the window for research of the EA4 component follows the masking delay. In the presence of a confirmed EA4 component, an atrioventricular delay is applied, counted from the EA4 component, and in the opposite case a predetermined escape interval is applied, counted from the last stimulated ventricular event.

Pacemaker with detection of atrial activity without collection of atrial electrical activity

A device includes a hemodynamic sensor measuring blood flow in the left chambers of a myocardium, at least one motion sensor measuring a displacement of the walls of the left ventricle of the myocardium, a first analysis module determining a time of closure of the aortic valve based on a signal of the hemodynamic sensor, a second analysis module determining a time of peak contraction of the left ventricle based on a signal from the motion sensors, and a third analysis module determining a time between the moment of peak contraction of the left ventricle and the moment of closure of the aortic valve. If the peak of contraction of the left ventricle is after the instant of closure of the aortic valve, the device adjusts the inter-ventricular delay and/or the atrioventricular delay to minimize or cancel the time disparity.

Device for assessment and therapy of temporal ventricular desynchronization

An medical device for stimulating the heart using biventricular stimulation. The device includes a sensor for detecting an endocardial acceleration parameter and a processing circuit configured to receive the endocardial acceleration parameter. The device further includes stimulation electronics coupled to the processing circuit. The processing circuit is configured to use the EA parameter to evaluate the biventricular stimulation. The evaluation includes comparing the value of the EA parameter in biventricular mode to the value of the EA parameter in left only mode or right only mode, and using the comparison and an assessment of the variability of the EA parameter as a function of the AVD in the left or right mode to distinguish between cases comprising: (a) normal operation, (b) a loss of RV or LV capture, (c) possible anodal stimulation. The processing circuit is further configured to conduct at least one update to operational parameters of the device based on the determined case.

An implantable medical device includes a sensor configured to generate an endocardial acceleration (EA) signal representative of activity of a patient's heart. The device further includes one or more circuits configured to identify within the EA signal at least one EA signal component corresponding to at least one peak of endocardial acceleration, and extract from the at least one EA signal component at least two characteristic parameters. The one or more circuits are further configured to generate a composite index based on a combination of the at least two characteristic parameters, determine a plurality of values of the composite index for a plurality of pacing configurations, and select a current pacing configuration from among the plurality of pacing configurations based on the plurality of values of the composite index.

Pacing configuration for an implantable medical device

A medical device for characterizing the cardiac status of a patient equipped with a bi-ventricular pacing active implant device. The implant collects an endocardiac acceleration signal and searches for an optimal pacing configuration. This latter tests a plurality of different pacing configurations and delivers for each tested configuration parameters derived from the endocardiac acceleration peak (PEA). The device derives a patient clinical status from those parameters, the indication being representative of the patient's response to the cardiac resynchronization therapy. Those parameters include: the possibility to automatically get or not a valid optimal AV Delay among all the biventricular pacing configurations; a factor indicating the character sigmoid of the PEA/AVD characteristic; the average value of the PEA for the various configurations; and the PEA signal/noise ratio. The active implantable medical device includes control software and processes for executing the characterizing functionality described.

Device for characterizing the cardiac status of a patient equipped with a biventricular pacing active implant

An apparatus and a system for seeking for an optimal configuration of a bi-, tri- or multi-ventricular cardiac resynchronization implantable medical device. This system includes ventricular pacing, a signal representative of an endocardial acceleration (EA) of a patient's heart, and isolating and pre-processing the EA signal to obtain an EA1 component and an EA2 component. The effectiveness of the current pacing configuration is evaluated by one or more composite indexes that combine at least two of the following parameters: peak-to-peak amplitude (PEA1) of the EA1 component; time occurrence (TstEA1) of the beginning of the EA1 component; time interval (LargEA1) between the beginning of the EA1 component and the moment of the energy peak of the EA1 component; and duration of systole (Syst), represented by the time interval between the beginning (TstEA1) of the EA1 component and the beginning (TstEA2) of the EA2 component.

System for seeking for an optimal configuration of a bi-, tri- or multi-ventricular cardiac resynchronization implanted device

An active implantable medical device for cardiac resynchronization with automatic optimization of atrioventricular and interventricular delays is disclosed. The device collects an endocardial acceleration signal EA and calculates the atrioventricular delay AVD and the interventricular delay VVD. The device isolate in the EA signal a component EA4 corresponding to the fourth EA peak and measure a temporal parameter related to a time interval between the detection of an atrial event (P/A) and the occurrence of the EA4 component. The device isolates an EA1 component corresponding to the first EA peak and measures a non-temporal parameter (A) related to the peak amplitude or a signal energy of the EA1 component. The optimal AVD (AVDO) is determined by the temporal parameter related to the EA4 component, and is calculated for a plurality of different values of VVD to obtain a plurality of pairs of optimal values {AVDO, VVD}. The device selects one of these pairs of values based on the non-temporal parameter related to the EA1 component.

Active implantable medical device for cardiac resynchronization with automatic optimization of atrioventricular and interventricular delays

An active implantable medical device with biventricular pacing and automatic optimization of pacing configuration. The device collects and analyzes an endocardial acceleration signal (EA), and searches for an optimal pacing configuration based upon a performance index derived from at least one value relating to one and/or the other of the two endocardial acceleration peaks (PEA I, PEA II) over a given heart cycle. Optimization search operates through a scanning of a parameter, e.g., atrio-ventricular delay, and calculation of the surface area underneath the characteristic of the peak amplitude as a function of the scanned parameter (atrioventricular delay).

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Borgofranco d'Ivrea, Italy

Fabrizio Renesto