WO2024199999A1

WO2024199999A1 - Medical system comprising an implantable cardiac pacemaker device and an implantable pressure sensor

Info

Publication number: WO2024199999A1
Application number: PCT/EP2024/056625
Authority: WO
Inventors: Dominic WIST; Bjoern Henrik Diem; Thomas KRUCZYK
Original assignee: Biotronik SE and Co KG
Current assignee: Biotronik SE and Co KG
Priority date: 2023-03-30
Filing date: 2024-03-13
Publication date: 2024-10-03
Anticipated expiration: 2025-09-30

Abstract

A medical system comprising an implantable cardiac pacemaker device (120) and an implantable pressure sensor (130) for measuring a patient's blood pressure, wherein the pacemaker device (120) and the pressure sensor (130) are configured to communicate with each other.

Description

MEDICAL SYSTEM COMPRISING AN IMPLANTABLE CARDIAC PACEMAKER DEVICE AND AN IMPLANTABLE PRESSURE SENSOR

A medical system generally comprises an implantable cardiac pacemaker device for cardiac resynchronization therapy (CRT). Patients whose left heart chamber does not beat in a synchronous way may be treated with such a therapy. Hereby, CRT may be used to optimize a left-ventricular output of the patient’s heart by resynchronizing the contraction of the left- ventricular appropriately.

Typically, the pacemaker device comprises a sensing arrangement comprising at least one electrical lead for sensing an electrocardiogram signal. The quality of resynchronization therapy partly depends on the position of the at least one electrical lead at the heart. It also depends on other conditions such as a polarity and a timing of pacing (with respect to the natural heart cycle) applied to the heart by the pacemaker device.

In order to find optimal initial pacing conditions, the left-ventricular output or a surrogate parameter is usually measured during rest invasively or noninvasively (e.g. by echocardiography) by a physician. Even if perfect initial conditions were determined this way, the quality of the resynchronization therapy may decrease over time because, for example, the optimal time point for the heart to receive the pacing may vary dynamically. In addition to the decrease of quality over time, it may be considered undesirable that the patient has to be present at a physician for each time optimal pacing conditions are determined.

The pacemaker device may be equipped with an adaptive algorithm which estimates the optimal conditions, in particular the timing of pacing, based on a timing of electrical signals produced by the natural heart beat measured through the at least one electrical lead. The electrical signals are only a surrogate parameter for the left-ventricular output (which is a target of the optimization procedure) but based on population data it is possible to determine an optimal contraction of the left-ventricular from these signals. This allows repetitive optimization of the pacing conditions without the patient having to be present at the physician.

Taking population data as the basis for determining pacing conditions neglects the patient’s individual features and an electromechanical delay that depends on the specific situation of the patient.

It is, therefore an object of the present invention to provide an improved medical system comprising an implantable cardiac pacemaker device capable of adapting to a patient’s individual features and a specific situation.

According to a first aspect of the invention, this object is achieved by providing a medical system according to claim 1.

Accordingly, the medical system comprises an implantable pressure sensor for measuring the patient’s blood pressure, wherein the pacemaker device and the pressure sensor are configured to communicate with each other.

The implantable pressure sensor may be a pulmonary artery pressure (PAP) monitor. In one embodiment, the pressure sensor is configured to be arranged in the pulmonary artery in order to measure the pulmonary pressure, in particular, the left-ventricular filling pressure. It may be implanted at the pulmonary artery because the pulmonary artery is easily accessible compared to other suitable measurement locations (e.g., the pulmonary vein). Such a location makes is desirable to design the pressure sensor as small as possible, e.g., provide it with a small battery, so that it does not pose to large an obstacle for the blood flow and to reduce the need for maintenance and repair of the pressure sensor, e.g., exchange of the battery, to an absolute minimum. Thus, the pressure sensor may be in a sleep state by default in order to save battery life. The pressure sensor may be configured to provide a first set of data in addition to another, optionally available, second set of data measured by the pacemaker device to characterize a left-ventricular output. The first set of data may include the blood pressure. The blood pressure measured at the pulmonary artery correlates to the left-ventricular filling pressure since the left-ventricular is connected to the pulmonary artery through the lung artery, the pulmonary veins and the pulmonary capillary. It may not be identical because the blood entering the pulmonary artery from the right-ventricular and circulating through the lungs to the left-ventricular encounters resistance, for example, in the form of a vascular resistance or a limited capacity of the left-ventricular to accept the incoming blood flow. The right- ventricular will generate sufficient blood pressure to overcome this resistance and the pressure at the left-ventricular will be lower than at the right-ventricular.

The lowest pulmonary artery pressure value, which is a pulmonary diastolic pressure of, for example, 4 to 13 mm Hg, may be a good estimation of the left-ventricular filling pressure. Alternatively or additionally to the pulmonary diastolic pressure, the first set of data may comprise a pulmonary artery mean pressure, which is, for example, between 9 to 19 mm Hg. The pulmonary diastolic pressure and the pulmonary artery mean pressure may increase under a cardiac disorder. Thus, it is desirable to optimize the contraction pattern through adjusting the pacing conditions based on a (measurable) minimization of the blood pressure.

The second set of data may include the electrocardiogram signal detected by the sensing arrangement including at least one electrode lead of the pacemaker device. Using the second set of data in addition to the first set of data may further increase the optimization of pacing conditions.

Communication between the pacemaker device and the pressure sensor may include transmitting and receiving information from each other. By communicating with each other, the pacemaker device and pressure sensor may allow an optimization of the pacing conditions individually to the patient.

In one embodiment, the pacemaker device is able to communicate with the pressure sensor wirelessly, in particular, through intra body communication. A wireless communication between the pacemaker device and the pressure sensor may be established through MICS (Medical Implant Communication Service) band, MEDS (Medical Device Radiocommunications Service) band, ISM (Industrial, Scientific and Medical) band, low energy coil telemetry, galvanic coupled telemetry, or Bluetooth, as examples.

In one embodiment, the pacemaker device is configured to choose at least one first candidate set of pacing parameters and operate using the at least one first candidate set; receive from the pressure sensor, at least one first blood pressure value, particularly a first pulmonary artery pressure value, measured during operation of the pacemaker device using the at least one first candidate set; choose at least one second candidate set of pacing parameters and operate using the at least one second candidate set; receive from the pressure sensor, at least one second blood pressure value, particularly a second pulmonary artery pressure value, measured during operation of the pacemaker device using the at least one second candidate set; and select as a new set of pacing parameters, from the at least one first and the at least one second candidate set, the candidate set which results in the lowest blood pressure. According to an embodiment, said lowest blood pressure corresponds to the lowest ventricular filling pressure.

In principle, a plurality of sets of pacing parameters may be provided for the pacemaker device to select the candidate sets from. For an efficient organization of the selection process, the pacemaker device may be configured to loop through a plurality of sets of pacing parameters choosing one candidate set after the other. The pacemaker device may choose from a group of the candidate sets or from all candidate sets, one by one, respectively. By choosing at least two candidate sets of pacing parameters, the pacemaker device may optimize pacing conditions by comparing obtained blood pressure values under each candidate set. The more candidate sets the pacing device chooses the better it may be able to determine the optimal pacing conditions.

Choosing at least one candidate set may be understood to comprise a choice out of a group of sets of pacing parameters. The choice may be based on a known optimization algorithm. Selecting a new set of pacing parameters may be understood to comprise a choice based on excellence with respect to optimal conditions (e.g., with respect to low blood pressure values) from the previously chosen sets of pacing parameters. Choosing and/or selecting may be understood to comprise application of the respective candidate set for pacing the patient’s heart.

Particularly, the pacing parameter which may be changed to optimize the left ventricular filling pressure are for example (but not limited to): the atrioventricular delay (in case of atrioventricular synchronous stimulation), the pacing configuration on ventricular level including the number of pacing sites, the ventrico-ventricular delay (in case of more than one pacing site), pacing mode, the atrial or ventricular pacing rate (dependent on stimulation mode) and rate adaption mode.

In one embodiment, a set of pacing parameters includes at least one of the timing of the pacing and a pacing polarity. The pacemaker device may, thus, adjust the timing of pacing and/or the pacing polarity when it chooses a candidate set or when it selects a new set of pacing parameters.

In one embodiment, the pressure sensor is configured to be switched between at least two states by a switching event, in particular, by a command signal received from the pacemaker device and/or a timer trigger of the pressure sensor that operates on a predetermined time interval. Since the pressure sensor may be in the sleep state by default, the switching event, in particular, the command signal and/or the timer trigger may be one way to wake up the pressure sensor. The command signal may comprise a wake-up signal that wakes up the pressure sensor or a sleep signal that, optionally, terminates an ongoing measurement and switches the pressure sensor to a sleep state. Other switching events such as a command signal transmitted to the pressure sensor from outside the patient’s body are conceivable, too.

In one embodiment, the command signal comprises an RF signal and/or a magnetic pulse. The RF signal may be a high-energy RF signal - that is an RF signal from an energy range in the upper half of the RF spectrum, in particular, in the range of 3 to 30 MHz. In particular, the signal may allow the pacemaker device to transmit a sufficient amount of energy to the pressure sensor so that it is ensured that the pressure sensor wakes up when receiving the signal. By transmitting the command signal to the pressure sensor, the pacemaker device may be able to control the pressure sensor. The design of the pressure sensor may be simplified if control is allocated to the pacemaker device.

According to an embodiment, the pacemaker device is configured to send a near-zero-power wake-up signal to the pressure sensor. The near-zero power wake-up signal is generated e.g. by a specific signal circuit and/or via specific sensors. See for instance the technology cited in “A Near-Zero-Power Wake-Up Receiver Achieving -69-dBm Sensitivity”, IEEE JOURNAL OF SOLID-STATE CIRCUITS, 0018-9200, 2018 IEEE; “Broadband Zero- Power Wakeup MEMS Device for Energy-Efficient Sensor Nodes”, Micromachines 2022, 13(3), 407; "Near-Zero Power Wake-Up Receivers for the Internet of Things” September 27, 2019, Moody, Jesse, Electrical Engineering - School of Engineering and Applied Science, University of Virginia.

Moreover, according to an embodiment of the present invention, the pacemaker device is configured to send wake-up signal to the pressure sensor which is based on intra body communication, in particular galvanic coupled telemetry. The galvanic coupled telemetry is performed by a first device (pacemaker device) which comprises means to change an electrical field of the body, and a second device (pressure sensor) which is able to detect the changes of the electrical field of the same body. The changes of the electrical field are modulated in a way by the first device that a specific signal or pattern can be recognized by the second device, which are interpreted as commands, e.g. a wake-up command. According to an embodiment, the first and the second device are configured to perform bidirectional communication based on galvanic coupled telemetry.

Alternatively or as an addition to the pressure sensor being able to receive the command signal, the pressure sensor may comprise a timer trigger that wakes up the pressure sensor after a predetermined sleep time, for example, on a monthly basis. The pressure sensor may measure at least one blood pressure value upon being woken up and transmit the at least one blood pressure value to the pacemaker device. After a predetermined amount of time or a predetermined number of measurements (for example, after ten measurements), the timer trigger switches the pressure sensor to a sleep state again. Thus, in one embodiment, one of the at least two states is a wake state in which the pressure sensor measures the blood pressure at least for the predetermined number of measurements or the predetermined amount of time and the other one is the sleep state in which the pressure sensor is asleep. The timer trigger may save the pacemaker device from having to transmit command signals to the pressure sensor that potentially deplete electrical energy of the pacemaker device. Such an arrangement may be particularly suitable if pacing conditions are desired to be optimized regularly so that a switching controlled by the pacemaker device is not required.

In one embodiment, the pressure sensor is configured to transmit measured blood pressure values to the pacemaker device according to a predefined communication timing pattern or based on a count of heart beats. An example for a predefined communication timing pattern may be a transmission of at least one measured blood pressure value every five seconds. Transmission according to the predefined communication timing pattern may be used, if the pressure sensor is desired to be operated for a longer amount of time and the measured blood pressure values do not have to be acquired immediately (i.e. as fast as a heartbeat). If the transmission is based on the count of heart beats (so-called beat-by-beat measurement), the pacemaker device may be able to obtain the most up-to-date information very quickly (e.g., every hundreds of milliseconds). Such a measurement approach may be particularly suitable for quick feedback on a candidate set of pacing parameters. A beat-by-beat measurement may be generally carried out for a predetermined number of heart beats, for example for five beats.

According to a second aspect of the invention, the object is also achieved by a method according to claim 11.

Accordingly, a method for selecting a new set of pacing parameters for operation of an implantable cardiac pacemaker device comprises the steps of: providing an implantable pressure sensor for measuring a patient’s blood pressure; choosing, by the pacemaker device, at least one first candidate set of pacing parameters and operating the pacemaker device using the at least one first candidate set; measuring, by the pressure sensor, the blood pressure during operation of the pacemaker device using the at least one first candidate set; choosing at least one second candidate set of pacing parameters and operating the pacemaker device using the at least one second candidate set; measuring, by the pressure sensor, the blood pressure during operation of the pacemaker device using the at least one second candidate set; and selecting, from the at least one first and the at least one second candidate set, by the pacemaker device, the candidate set which results in the lowest blood pressure as the new set of pacing parameters.

In order for the pacemaker device to select the new set of pacing parameters based on the blood pressure, the pressure sensor may transmit a first blood pressure value measured during operation of the pacemaker device using the at least one first candidate set and a second blood pressure value measured during operation of the pacemaker device using the at least one second candidate set to the pacemaker device as described above. In principle, other approaches that enable the pacemaker device to determine the lowest blood pressure are considerable, for example, the pressure device may only transmit an indication to the pacemaker device which measurement resulted in the lowest blood pressure, thereby saving electrical energy used for transmission power.

In one embodiment, the at least one first candidate set and the at least one second candidate set are generated by the pacemaker device through an optimization algorithm. Such optimization algorithms are known and therefore not described to any further detail. It shall be noted, however, that an arbitrary number of candidate sets may be generated through the optimization algorithm and the one resulting in the lowest blood pressure value may be selected as the new set of pacing parameters.

According to a third aspect of the invention, the object is achieved by an implantable pacemaker device configured to communicate with a pressure sensor for measuring a patient’s blood pressure.

The communication between the pacemaker device and the pressure sensor can be achieved by the following method comprising the steps of: providing a programming device configured to communicate with the medical device and the pressure sensor; informing, by the programming device, the medical device of the presence of the pressure sensor and the pressure sensor of the presence of the medical device; and communicating, by the medical device, with the pressure sensor.

Such a method may be used during an interrogation process. A cardiologist may use the programming device during the interrogation process to communicate with the medical system. The programming device is configured to detect the presence of the medical device and the pressure sensor. The medical device and the pressure sensor may each store a set of parameters which may be interrogated by the programming device. The set of parameters may comprise an indication of whether or not each of the devices knows of the presence of the other one. Through obtaining the set of parameters, the programming device may be able to check whether the medical device knows of the pressure sensor and the pressure sensor knows of the medical device. The interrogation process may be carried out whilst the medical device and pressure sensor are implanted with the patient.

If the medical device and/or pressure sensor does not know of the presence of the other one, the programming device may be configured to set the corresponding parameter(s) in the medical device and/or the pressure sensor. This could be done in a programming process, which may be carried out after the interrogation process. After setting the corresponding parameter(s), the medical device may be aware of the presence of the pressure sensor so that it can communicate with the pressure sensor. The communication may, in particular, comprise transmitting the wake-up signal to the pressure sensor to wake up the pressure sensor from the sleep state. Analogously, after setting the corresponding parameter(s), the pressure sensor may be aware of the presence of the medical device so that it can communicate with the medical device. The communication may, in particular, comprise that the pressure sensor is woken up by the medical device. In other words, the medical device may be able to trigger the pressure sensor and the pressure sensor may be able to get triggered by the medical device after both of them are informed about presence of each other. According to a fourth aspect of the invention, the object is achieved by an implantable pressure sensor for measuring a patient’s blood pressure configured to communicate with an implantable pacemaker device.

The advantages and advantageous embodiments described above for the first aspect of the invention may also be applied to the method according to the second aspect of the invention, to the pacemaker device according to the third aspect of the invention and to the pressure sensor according to the fourth aspect of the invention such that it shall be referred to the above in this respect.

The idea of the invention shall subsequently be described in more detail with reference to the embodiments as shown in the drawings. Herein:

Fig. 1 shows a schematic drawing of a medical system in an implanted state in a patient; and

Fig. 2 shows an illustration of a medical system in communication with a programming device; and

Fig. 3 shows a medical system operational on a patient’s heart.

Subsequently, embodiments of the invention shall be described in detail with reference to the drawings. In the drawings, like reference numerals designate like structural elements.

It is to be noted that the embodiments are not limiting for the invention, but merely represent illustrative examples.

Referring to Fig. 1, a medical system is shown in an implanted state in a patient 110. The pressure sensor 130 is implanted at the patient’s heart 111 in the pulmonary artery. It is operational to communicate wirelessly with a pacemaker device 120, e.g., a CRT implant, implanted near the patient’s heart 111. The pressure sensor 130 measures the patient’ s blood pressure if it is in an operational state. An interrogation and a programming process are shown schematically in Fig. 2. During the interrogation process, the programming device 140 may find the pacemaker device 120 and the pressure sensor 130. The programming device 140 may then extract at least one parameter from the pacemaker device 120 and the pressure sensor 130 in order to check whether the two implants are already informed of the presence of each other. During the programming process, the programming device 140 may set the at least one parameter so that the pacemaker device 120 and pressure sensor 130 are informed of the presence of each other. If the pacemaker device 120 knows about the presence of the pressure sensor 130, it can trigger the pressure sensor 130 if necessary. Triggering the pressure sensor 130 may, for example, be done by transmitting a wake-up signal to the pressure sensor 130. If the pressure sensor 130 knows about the presence of the pacemaker device 120, it can get triggered by the pacemaker device 120. Getting triggered by the pacemaker device 120 may, for example, include waking up upon reception of a wake-up signal from the pacemaker device 120.

Fig. 3 shows an illustration of a medical system operational on a patient’s heart 111, in particular, how the pacemaker device 120 and pressure sensor 130 communicate with each other in order to optimize pacing parameters to minimize the left-ventricular filling pressure.

Initially, the pacemaker device 120 provides pacing to the patient’s heart 111 using an initial set of pacing parameters. The initial set of pacing parameters may have been set by a physician or during a previous optimization run of the pacing parameters. During pacing, the pacemaker device 120 uses sensing A through at least one electrical lead of a sensing arrangement of the pacemaker device 120 in order to determine an electrocardiogram signal. Through the sensing, the pacemaker device continuously checks the heart rhythm based on electrical inputs from the at least one electrical lead.

Optimization of pacing parameters is initiated by generating at least one first candidate set and at least one second candidate set by the pacemaker device 120 through an optimization algorithm. Such candidate sets may, for example, comprise a timing of pacing and/or a polarity of pacing. The generated candidate sets may be different (in terms of the value of their parameters) from the initially used set of pacing parameters. Firstly, the pacemaker device 120 transmits a wake-up signal 1 to the pressure sensor 130 in order to wake up the pressure sensor 130 from a sleep state. The wake-up signal 1 may be generated by the pacemaker device 120 through a high-energy RF signal or a magnetic pulse. The wake-up signal 1 triggers the pressure sensor 130 to switch from the sleep state to an operational state.

In a second step, the pressure sensor 130, now in its operational state, detects the blood pressure by sensing 2 the heart 111. The sensing 2 is performed through a pressure measurement at the pulmonary artery. Specifically, the left-ventricular filling pressure is measured. A timing of the measurement may be based on a count of heart beats, i.e., a beat- by-beat measurement. Other types of timings, for example a measurement every five seconds are also conceivable.

In a third step, the pressure sensor 130 transmits measured blood pressure values to the pacemaker device 120 based on the count of heart beats. Such blood pressure values are indicated as pulmonary artery pressure values (PAP values 3) - the specific measurement location may be understood as exemplary and not limiting to the present embodiment since the blood pressure values could be measured elsewhere, too. The transmission based on the count of heart beats may comprise transmitting measured values during the measurement (i.e., as the values come in) so that the pacemaker device 120 quickly obtains newly measured values. Other types of transmission schemes such as transmission according to a predefined communication timing pattern are also conceivable. The pacemaker device 120 may be configured to store the received blood pressure values in order to compare values from different sets of candidate parameters at a later stage.

According to an embodiment, the pressure sensor 130 transmits measured blood pressure values to the pacemaker device 120 in a periodical fashion. For instance, the pressure sensor 130 will transmit blood pressure values once per day tot he pacemaker device 120. For such implementation, a regular time synchronization between the pressure sensor 130 and pacemaker device 120 is required. In a fourth step, the pacemaker device 120 chooses the at least one candidate set of pacing parameters for pacing 4 the patient’s heart 111. The at least one first candidate set may be applied as soon as the pacemaker device 120 has received a first blood pressure value from the pressure sensor 130 because at this stage pressure sensor 130 is operational and the pacemaker device 120 can receive blood pressure values from applied candidate sets from the pressure sensor 130. The pacemaker device 120 is configured to loop through all candidate sets of pacing parameters (in the present embodiment, there are only two candidate sets - in principle any number of candidate sets may be chosen). Each candidate set may be applied for a predetermined amount of time or heartbeats, for example for five seconds or for five heartbeats, before the next candidate set is chosen by the pacemaker device 120. As a result, the pacemaker device 120 is able to collect from the pressure sensor 130 blood pressure values for each candidate set of pacing parameters measured over the predetermined amount of time.

In a fifth step, after the at least one first and the at least one second candidate set have been measured, the pacemaker device 120 transmits a sleep signal 5 to the pressure sensor 130 in order to send the pressure sensor 130 to sleep which may save battery life of the pressure sensor 130. The sleep signal 5 may be generated by the pacemaker device 120 through a high-energy RF signal or a magnetic pulse. Upon reception of the sleep signal 5, the pressure sensor 130 stops an ongoing blood pressure measurement and returns to the sleep state. Thus, the sleep signal 5 triggers the pressure sensor 130 to switch from the operational state to the sleep state.

In a sixth step, the pacemaker device 120 selects, as a new set of pacing parameters, from the at least one first and the at least one second candidate set, the candidate set which results in the lowest blood pressure. Selecting the new set of pacing parameters comprises applying the new set for pacing 6 the patient’s heart 111. With the new set of pacing parameters, the patient 110 may benefit from an adaptation to his/her individual features and specific situation reflected in the optimized blood pressure value. List of reference numerals

1 wake-up signal

2 sensing by pressure sensor 3 transmitting PAP values

4 pacing with candidate set of pacing parameters

5 sleep signal

6 pacing with final/optimized set of pacing parameters

A sensing by pacemaker device 110 patient

111 heart

120 pacemaker device

130 pressure sensor

Claims

1. A medical system comprising an implantable cardiac pacemaker device (120), characterized by an implantable pressure sensor (130) for measuring a patient’s blood pressure, wherein the pacemaker device (120) and the pressure sensor (130) are configured to communicate with each other.

2. The medical system of claim 1, characterized in that the pacemaker device (120) is able to communicate with the pressure sensor (130) wirelessly, in particular, through intra body communication.

3. The medical system of one of claims 1 or 2, characterized in that the pressure sensor (130) is configured to be arranged in the pulmonary artery in order to measure the pulmonary pressure, in particular, the left-ventricular filling pressure.

4. The medical system of one of claims 1 to 3, characterized in that the pacemaker device (120) is configured to

- choose at least one first candidate set of pacing parameters and operate using the at least one first candidate set;

- receive from the pressure sensor (130), at least one first blood pressure value, particularly a first pulmonary artery pressure value, measured during operation of the pacemaker device (120) using the at least one first candidate set;

- choose at least one second candidate set of pacing parameters and operate using the at least one second candidate set;

- receive from the pressure sensor (130), at least one second blood pressure value, particularly a second pulmonary artery pressure value, measured during operation of the pacemaker device (120) using the at least one second candidate set; and

- select as a new set of pacing parameters, from the at least one first and the at least one second candidate set, the candidate set which results in the lowest blood pressure, wherein particularly the lowest blood pressure corresponds to the lowest ventricular filling pressure.

5. The medical system of claim 4, characterized in that a set of pacing parameter includes at least one of a timing of the pacing and a pacing polarity.

6. The medical system of one of the preceding claims, characterized in that the pressure sensor (130) is configured to be switched between at least two states by a switching event, in particular, by a command signal received from the pacemaker device (120) and/or a timer trigger of the pressure sensor (130) that operates on predetermined time intervals.

7. The medical system of claim 6, characterized in that the command signal comprises an RF signal and/or a magnetic pulse.

8. The medical system of one of claims 6 or 7, characterized in that one of the at least two states is a wake state in which the pressure sensor (130) measures the blood pressure at least for a predetermined number of measurements or a predetermined amount time and the other one is a sleep state in which the pressure sensor (130) is asleep.

9. The medical system of one of the preceding claims, characterized in that the pressure sensor (130) is configured to transmit measured blood pressure values to the pacemaker device (120) according to a predefined communication timing pattern or based on a count of heart beats.

10. A method for selecting a new set of pacing parameters for operation of an implantable cardiac pacemaker device (120) comprising the steps of

- providing an implantable pressure sensor (130) for measuring a patient’s blood pressure, particularly the pulmonary artery pressure; - choosing, by the pacemaker device (120), at least one first candidate set of pacing parameters and operating the pacemaker device (120) using the at least one first candidate set;

- measuring, by the pressure sensor (130), the blood pressure, particularly the pulmonary artery pressure, during operation of the pacemaker device (120) using the at least one first candidate set;

- choosing at least one second candidate set of pacing parameters and operating the pacemaker device (120) using the at least one second candidate set;

- measuring, by the pressure sensor (130), the blood pressure, particularly the pulmonary artery pressure during operation of the pacemaker device (120) using the at least one second candidate set; and

- selecting, from the at least one first and the at least one second candidate set, by the pacemaker device (120), the candidate set which results in the lowest blood pressure as the new set of pacing parameters, wherein particularly the lowest blood pressure corresponds to the lowest ventricular filling pressure.

11. The method of claim 10, characterized in that the at least one first candidate set and the at least one second candidate set are generated by the pacemaker device (120) through an optimization algorithm.

12. An implantable cardiac pacemaker device (120) configured to communicate with a pressure sensor (130) for measuring a patient’s blood pressure.

13. An implantable pressure sensor (130) for measuring a patient’s blood pressure configured to communicate with an implantable cardiac pacemaker device (120).