Systems and methods for stimulation site selection

Abstract

Systems and methods for selecting one or more sites at or within at least one heart chamber for cardiac stimulation are disclosed. The system can include a physiologic sensor circuit to sense physiologic signals at two or more candidate stimulation sites. The system can generate respective activation timing indicators corresponding to the two or more candidate stimulation sites, and detect MI indicators indicating the presence of, or spatial proximity of each of the two or more candidate stimulation sites to a MI tissue. The system can use the activation timing indicators and the MI indicators to select at least one target stimulation site or to determine an electrostimulation vector. The system can display the selected target stimulation site to a user, or deliver electrostimulation to the patient at the target stimulation site or according to the determined electrostimulation vector.

What is claimed is: 
     
         1 . A system, comprising:
 an electrostimulation vector assessment circuit configured to receive:
 for a plurality of candidate stimulation vectors, respective MI indications for two or more of the plurality of candidate stimulation vectors; and 
 for the two or more of the plurality of candidate stimulation vectors, respective second indicators indicative of one or more of therapy efficacy, battery longevity, or stimulation complication; 
   wherein the electrostimulation vector assessment circuit is configured to display a selectable subset of the plurality of candidate electrostimulation vectors associated with the respective MI indications and the respective second indicators, and to store a selected candidate electrostimulation vector for subsequent delivery of electrostimulation energy.   
     
     
         2 . The system of  claim 1 , wherein the electrostimulation vector assessment circuit is configured to display a table of the selectable subset of the plurality of candidate electrostimulation vectors and the associated respective MI indications and respective second indicators. 
     
     
         3 . The system of  claim 1 , wherein the electrostimulation vector assessment circuit is configured to receive a user selection of a target electrostimulation vector from the selectable subset. 
     
     
         4 . The system of  claim 1 , wherein the electrostimulation vector assessment circuit is configured to select a target electrostimulation vector from the selectable subset based on the respective MI indications and the respective second indicators of the candidate electrostimulation vectors in the selectable subset. 
     
     
         5 . The system of  claim 1 , wherein the electrostimulation vector assessment circuit is configured to rank the candidate electrostimulation vectors in the selectable subset, the ranking including:
 generating first ranked vectors by ranking the candidate electrostimulation vectors in the selectable subset according to a first indicator; and   generating second ranked vectors by ranking at least a portion of the first ranked vectors according to a second indicator different from the first indicator, the portion of the first ranked vectors having corresponding first indicators satisfying a specified condition; and   wherein the first and second indicators are selected from MI indications, therapy efficacy indicators, battery longevity indicators, or complication indicators.   
     
     
         6 . The system of  claim 1 , comprising a therapy circuit configured to deliver electrostimulation according to a user selected or an automatically determined target electrostimulation vector. 
     
     
         7 . The system of  claim 1 , wherein the received MI indications include amplitudes of respective left ventricular (LV) electrograms respectively sensed at cardiac sites corresponding to the plurality of candidate stimulation vectors. 
     
     
         8 . The system of  claim 7 , wherein the received MI indications include:
 a first categorical value of spatial proximity to MI if the LV electrogram amplitude falls below a threshold; or   a second categorical value of spatial remoteness to, or absence of, MI if the LV electrogram amplitude exceeds the threshold.   
     
     
         9 . The system of  claim 1 , wherein the received second indicators include therapy efficacy indicators indicating a therapeutic effect of electrostimulation delivered according to a candidate electrostimulation vector. 
     
     
         10 . The system of  claim 9 , wherein the therapy efficacy indicators include measurements of one or more of:
 a hemodynamic parameter;   a capture threshold;   a cardiac timing interval;   an inter-ventricular delay; or   an intra-ventricular delay.   
     
     
         11 . The system of  claim 1 , wherein the received second indicators include battery longevity indicators indicating projected remaining lifetime of a battery when electrostimulation is delivered according to a candidate electrostimulation vector. 
     
     
         12 . The system of  claim 1 , wherein the received second indicators include complication indicators indicating unintended nerve or skeletal muscle stimulation in response to electrostimulation delivered according to a candidate electrostimulation vector. 
     
     
         13 . The system of  claim 12 , wherein the complication indicators includes measurements of one or more of:
 a phrenic nerve activation;   a phrenic nerve stimulation threshold (PNS T ) indicative of minimum electrostimulation intensity sufficient to elicit phrenic nerve activation; or   a safety margin indicative of a relationship between the PNS T  and a cardiac capture threshold.   
     
     
         14 . A method, comprising:
 receiving, for a plurality of candidate stimulation vectors, respective MI indications for two or more of the plurality of candidate stimulation vectors using an electrostimulation vector assessment circuit;   receiving, for the two or more of the plurality of candidate stimulation vectors, respective second indicators indicative of one of more of therapy efficacy, battery longevity, or stimulation complication using the electrostimulation vector assessment circuit;   displaying a selectable subset of the plurality of candidate electrostimulation vectors associated with the respective MI indications and the respective second indicators using the electrostimulation vector assessment circuit; and   storing a selected candidate electrostimulation vector for subsequent delivery of electrostimulation energy using the electrostimulation vector assessment circuit.   
     
     
         15 . The method of  claim 14 , comprising displaying a table that includes information of the selectable subset of the plurality of candidate electrostimulation vectors and the associated respective MI indications and respective second indicators. 
     
     
         16 . The method of  claim 15 , further comprising receiving a user selection of a target electrostimulation vector from the selectable subset. 
     
     
         17 . The method of  claim 14 , comprising selecting a target electrostimulation vector from the selectable subset based on the respective MI indications and the respective second indicators of the candidate electrostimulation vectors in the selectable subset. 
     
     
         18 . The method of  claim 14 , comprising delivering electrostimulation according to a user selected or an automatically determined target electrostimulation vector. 
     
     
         19 . The method of  claim 14 , wherein the received second indicators include measurements one or more of:
 a hemodynamic parameter;   a capture threshold;   a cardiac timing interval;   an inter-ventricular delay;   an intra-ventricular delay; or   a phrenic nerve activation.   
     
     
         20 . The method of  claim 14 , wherein the received MI indications include amplitudes of respective left ventricular (LV) electrograms sensed at a cardiac site corresponding to the plurality of candidate stimulation vectors.