Closed-loop adaptive adjustment of pacing therapy based on cardiogenic impedance signals detected by an implantable medical device

Abstract

Techniques are provided for controlling therapy provided by the implantable cardiac stimulation device based on cardiogenic impedance. A cardiogenic impedance signal (or intracardiac impedance signal) is an impedance signal representative of the beating of the heart of the patient in which the device is implanted. The cardiogenic impedance signal is sensed along a sensing vector passing through at least a portion of the heart so that the sensed impedance is affected by the mechanical beating of the heart along that sensing vector. Pacing therapy is automatically and adaptively adjusted based on the cardiogenic impedance signal. For example, pacing timing parameters such as the atrioventricular delay and the inter-ventricular delay may be adjusted. Preferably, the adjustments are adaptive, i.e. the adjustments are performed in a closed-loop so as to adapt the adjustments to changes in the cardiogenic impedance signal so as to optimize therapy. In one particular example, the adjustments are performed so as to reduce a degree of fractionation within a cardiogenic impedance waveform.