US6643546B2
Expired / Lapsed
US
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Multi-electrode apparatus and method for treatment of congestive heart failure
Assignee: Quetzal Biomedical Inc
•
Filing: 2002-02-13
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Granted: 2003-11-04
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Expires: 2022-02-13
Abstract
Abstract An apparatus and method for treatment of congestive heart failure from the right side of the heart. An implantable cardiac stimulation system with a multi-electrode lead having three or more selectable electrodes, together with apparatus for identifying an optimal subset of electrodes, apparatus for shaping a propagating wave front, and apparatus for modifying the intrinsic ventricular cardiac activation sequence, or generating simultaneous or near simultaneous pacing pulses to the septum or right ventricular outflow tract during ventricular systole in order to improve left ventricular cardiac efficiency and reduce mitral regurgitation in patients with dilated cardiomyopathy. A three dimensional map of electrode placement may be calculated. A sub set of the available electrodes in the right side of the heart is selected for stimulation such that septal motion during systole is reduced or the mitral valve area is stiffened to reduce mitral regurgitation.
Inventors
- 👤 Scott Mathis
- 👤 John K. Prentice
- 👤 John A. Schmidt
- 👤 William B. Rottenberg
Bibliographic Details
Application Number
—
Jurisdiction
US
Data Source
google_patents
Last Synchronized
2026-10-23 13:45
CPC Classifications
A; A61; A61N; A61N1/00; A61N1/18; A61N1/32; A61N1/36; A61N1/362; A61N1/365; A61N1/368; A61N1/3627; A61N1/3684; A61N1/36842; A61N1/3686
Claims Analysis
Total Claims: 37
Claim 1
Independent Claim
88 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, selecting a subset of said electrodes lying on the right septal wall for stimulating the heart such that stimulation through said set of electrodes improves cardiac performance, and stimulating the heart through said set of electrodes.
Claim 2
Independent Claim
88 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, selecting a subset of said electrodes lying on the right septal wall for stimulating the heart such that stimulation through said set of electrodes improves cardiac performance, and stimulating the heart through said set of electrodes.
Claim 3
Dependent Claim
36 words
The method of claim 1 further comprising developing a plurality of template patterns of wave fronts passing said electrodes and distinguishing between intrinsic and ectopic wave fronts by comparing sensed wave fronts to said template patterns.
Claim 4
Dependent Claim
27 words
The method of claim 1 wherein the step of selecting said set of electrodes further comprises selecting a set of electrodes to stiffen the septum during systole.
Claim 5
Dependent Claim
28 words
The method of claim 1 wherein the step of selecting said set of electrodes comprises selecting a set of electrodes to reduce motion of the septum during systole.
Claim 6
Dependent Claim
13 words
The method of claim 4 wherein the motion of the septum is imaged.
Claim 7
Dependent Claim
22 words
The method of claim 3 wherein the septum is stimulated within at least the first 10 per cent of ventricular contraction time.
Claim 8
Dependent Claim
25 words
The method of claim 3 wherein the step of stimulating the heart comprises stimulating at said set of electrodes to stiffen the septum substantially simultaneously.
Claim 9
Dependent Claim
36 words
The method of claim 3 wherein the step of stimulating the heart comprises stimulating at said set of electrodes to stiffen the septum in a sequence such that substantially all of the septum stiffens substantially simultaneously.
Claim 10
Dependent Claim
28 words
The method of claim 1 wherein said multi-electrode lead is implanted from the right ventricular outflow tract along the right ventricular septal wall to the right ventricular apex.
Claim 11
Dependent Claim
39 words
The method of claim 1 wherein the set of electrodes lying on the septal wall is selected by identifying a set of electrodes close to a line connecting two electrodes that are known to lie on the septal wall.
Claim 12
Dependent Claim
27 words
The method of claim 1 wherein the step of selecting a set of electrodes further comprises selecting a set of electrodes near the right ventricular outflow tract.
Claim 13
Dependent Claim
30 words
The method of claim 11 wherein the step selecting said set of electrodes further comprises selecting a set of electrodes to stiffen the heart around the mitral valve during systole.
Claim 14
Dependent Claim
20 words
The method of claim 12 wherein the mitral regurgitation is minimized by stimulation from the right side of the heart.
Claim 15
Dependent Claim
14 words
The method of claim 13 wherein mitral regurgitation is imaged by an echo cardiogram.
Claim 16
Dependent Claim
48 words
The method of claim 1 wherein the step of implanting said multi-electrode lead comprises distributing sufficient electrodes on the right ventricular septal wall such that at least fifty per cent of the right ventricular wall could be stimulated within the first ten percent of the ventricular contraction time.
Claim 17
Dependent Claim
15 words
The method of claim 15 wherein said electrodes are within 8 mm of each other.
Claim 18
Dependent Claim
15 words
The method of claim 16 wherein the electrodes are within 4 mm of each other.
Claim 19
Dependent Claim
31 words
The method of claim 1 wherein the step of selecting a set of said electrodes comprises stimulating said heart to locate an electrode lying near a sweet spot in the heart.
Claim 20
Dependent Claim
34 words
The method of claim 18 further comprising stimulating at at least one electrode, sensing a physiologic parameter correlated to cardiac output, and selecting an electrode or electrodes such that said cardiac output is maximized.
Claim 21
Dependent Claim
23 words
The method of claim 1 wherein the step of selecting a set of electrodes comprises determining a three dimensional position for each electrode.
Claim 22
Dependent Claim
37 words
The method of claim 1 wherein the step of selecting a set of electrodes comprises mapping the progress of a wave front through at least a portion of the heart past at least some of said electrodes.
Claim 23
Dependent Claim
20 words
The method of claim 21 wherein said step of mapping a wave front comprises mapping an intrinsic contraction wave front.
Claim 24
Dependent Claim
32 words
The method of claim 21 wherein the step of mapping a wave front comprises stimulating the heart at at least one electrode and sensing a resulting wave front propagating through the heart.
Claim 25
Dependent Claim
20 words
The method of claim 1 wherein the step of stimulating the heart comprises sequentially stimulating at a plurality of electrodes.
Claim 26
Dependent Claim
27 words
The method of claim 24 wherein sequentially stimulating comprises stimulating at said electrodes to cause the contraction wave form to conform to a selected normal wave form.
Claim 27
Independent Claim
110 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, developing a plurality of template patterns of wave fronts passing said electrodes; distinguishing between intrinsic and ectopic wave fronts by comparing sensed wave fronts to said template patterns; selecting a subset of said electrodes for stimulating the heart such that stimulation through said set of electrodes improves cardiac performance, and stimulating the heart through said set of electrodes.
Claim 28
Independent Claim
110 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, developing a plurality of template patterns of wave fronts passing said electrodes; distinguishing between intrinsic and ectopic wave fronts by comparing sensed wave fronts to said template patterns; selecting a subset of said electrodes for stimulating the heart such that stimulation through said set of electrodes improves cardiac performance, and stimulating the heart through said set of electrodes.
Claim 29
Independent Claim
128 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, selecting a first subset of said electrodes near the right ventricular outflow tract; stimulating the heart through said first subset of said electrodes; determining a first regurgitation through the mitral valve; selecting a second subset of said electrodes near the right ventricular outflow tract, stimulating the heart through said second set of electrodes, determining a second regurgitation through the mitral valve, and choosing the subset of electrodes such that regurgitation through the mitral valve is minimized.
Claim 30
Independent Claim
128 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, selecting a first subset of said electrodes near the right ventricular outflow tract; stimulating the heart through said first subset of said electrodes; determining a first regurgitation through the mitral valve; selecting a second subset of said electrodes near the right ventricular outflow tract, stimulating the heart through said second set of electrodes, determining a second regurgitation through the mitral valve, and choosing the subset of electrodes such that regurgitation through the mitral valve is minimized.
Claim 31
Dependent Claim
32 words
The method of claim 27 further comprising selecting additional subsets of said electrodes, determining regurgitation for each of said subsets and choosing an optimum subset from all of said subsets of electrodes.
Claim 32
Independent Claim
113 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, selecting a subset of said electrodes lying on the right septal wall by selecting a first electrode near the right ventricular outflow tract, selecting a second electrode near the apex of the right ventricular chamber, and identifying electrodes on the septal wall adjacent a shortest path connecting said first and second electrodes, and stimulating the heart through said set of electrodes.
Claim 33
Independent Claim
113 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, selecting a subset of said electrodes lying on the right septal wall by selecting a first electrode near the right ventricular outflow tract, selecting a second electrode near the apex of the right ventricular chamber, and identifying electrodes on the septal wall adjacent a shortest path connecting said first and second electrodes, and stimulating the heart through said set of electrodes.
Claim 34
Independent Claim
97 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, mapping the progress of a wave front past said electrodes; selecting a subset of said electrodes for stimulating the heart in a sequence such that recreates the progress of said mapped wave front, and stimulating the heart through said set of electrodes in said sequence.
Claim 35
Independent Claim
97 words
A method for treating congestive heart failure comprising implanting a multi-electrode lead in at least the right ventricle of the heart of a patient, said multi-electrode lead having at least three selectable electrodes, implanting a cardiac stimulator in the body of said patient, said cardiac stimulator being connected to said multi-electrode lead, mapping the progress of a wave front past said electrodes; selecting a subset of said electrodes for stimulating the heart in a sequence such that recreates the progress of said mapped wave front, and stimulating the heart through said set of electrodes in said sequence.
Claim 36
Dependent Claim
39 words
The method of claim 30 wherein said step of stimulating the heart through said set of electrodes further comprises inhibiting stimulation at any individual electrode whenever an advancing wave front recreates said mapped wave front at said individual electrode.
Claim 37
Dependent Claim
23 words
The method of claim 30 wherein said step of mapping the progress of said wave front comprises mapping an intrinsic contraction wave front.
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USPTO Annuity & Maintenance Windows
| Annuity Stage | Window Opens | Payment Deadline | Surcharge Period Until | Estimated Fee | Status |
|---|---|---|---|---|---|
| 3.5 Years (Year 4) | 2006-11-03 | 2007-05-05 | 2007-11-04 | $2000.00 | Window Closed / Lapsed |
| 7.5 Years (Year 8) | 2010-11-03 | 2011-05-05 | 2011-11-04 | $3760.00 | Window Closed / Lapsed |
| 11.5 Years (Year 12) | 2014-11-03 | 2015-05-05 | 2015-11-04 | $7700.00 | Window Closed / Lapsed |