Refractory and blanking intervals in the context of multi-site left ventricular pacing

• US 10,052,488 B2
• Filed: 10/01/2015
• Issued: 08/21/2018
• Est. Priority Date: 12/20/2010
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Gilkerson, James O., Kalgren, James, Siejko, Krzysztof Z., Stahmann, Jeffrey E.
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Piateski, Erin M
• Application Number:
  US14/872,965
• Publication Number:
  US 20160089539A1
• Time in Patent Office: 1,055 Days
• Field of Search: 607 18
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A refractory period for a pacemaker sensing channel refers to a period of time during which the sensing channel is either blind to incoming electrical signals, termed a blanking interval, and/or during which the device is configured to ignore such signals for purposes of sense event detection. Methods and devices for implementing refractory periods in the context of multi-site left ventricular pacing are described.

Claims

1. A cardiac pacing system, comprising:

pulse generation circuitry for generating pacing pulses;

sensing circuitry for sensing cardiac electrical activity;

a controller for detecting cardiac events that define pacing timing intervals and for controlling the delivery of pacing pulses in accordance with a programmed mode;

wherein the controller is programmed to;

sense cardiac activity through a right ventricular sensing channel;

schedule delivery of paces through left ventricular pacing channels to at least two left ventricular sites designated LV1 and LV2 during a cardiac cycle interval that is reset by a right ventricular sense;

define selected refractory periods such that during a refractory period for a sensing channel, either the sensing channel is blind to the incoming electrical signals or the controller is configured to ignore incoming electrical signals for the purposes of event detection;

initiate a post-pace refractory period for the right ventricular sensing channel when the first ventricular pace is delivered during a cardiac cycle; and

,

after initiation of the post-pace refractory periods for the right ventricular sensing channel when a first ventricular pace is delivered to site LV1, leave the post-pace refractory period unaffected by a subsequent pace to site LV2.

2. The system of claim 1 wherein the controller is further programmed to:

sense cardiac activity through a left ventricular sensing channel;

initiate a post-pace refractory period for the left ventricular sensing channel when the first ventricular pace is delivered during a cardiac cycle.

3. The system of claim 1 wherein the controller is programmed to initiate a post-sense refractory period for any sensing channel when a sense is detected in that sensing channel.

4. The system of claim 1 wherein the controller is further programmed to:

sense atrial activity through an atrial sensing channel; and

,

initiate a post-pace refractory period for the atrial sensing channel for each ventricular pace delivered during a cardiac cycle.

5. The system of claim 2 wherein the controller is programmed such that the post-pace refractory periods initiated upon delivering the left ventricular paces to sites LV1 and LV2 use the same programmed settings.

6. The system of claim 2 wherein the controller is further programmed to:

deliver a pace to the right ventricle through a right ventricular pacing channel during a cardiac cycle interval and subsequently deliver left ventricular paces to sites LV1 and LV2 during the cardiac cycle interval unless inhibited by a right ventricular sense;

reset the cardiac cycle interval upon either a right ventricular sense or a right ventricular pace;

after initiation of post-pace refractory periods for the right and left ventricular sensing channels when the right ventricular pace is delivered, leave the post-pace refractory periods unaffected by the subsequent paces to LV1 and LV2.

7. The system of claim 2 wherein the controller is further programmed to:

after delivery of left ventricular paces to sites LV1 and LV2, deliver a pace to the right ventricle through a right ventricular pacing channel during a cardiac cycle interval unless inhibited by a right ventricular sense;

reset the cardiac cycle interval upon either a right ventricular sense or a right ventricular pace;

after initiation of post-pace refractory periods for the right and left ventricular sensing channels when a first ventricular pace is delivered to site LV1, leave the post-pace refractory periods unaffected by the subsequent pace to site LV2 and the right ventricular pace.

8. The system of claim 2 wherein the controller is further programmed to:

deliver a left ventricular pace to site LV1 coincident with a right ventricular pseudo-pace and subsequently deliver a left ventricular pace to site LV2 during a cardiac cycle interval unless inhibited by a right ventricular sense;

reset the cardiac cycle interval upon either a right ventricular sense or a right ventricular pseudo-pace;

after initiation of post-pace refractory periods for the right and left ventricular sensing channels when a first ventricular pace is delivered to site LV1, leave the post-pace refractory periods unaffected by the subsequent pace to site LV2.

9. The system of claim 2 wherein the controller is further programmed to:

deliver a left ventricular pace to site LV1 and subsequently deliver a left ventricular pace to site LV2 coincident with a right ventricular pseudo-pace during a cardiac cycle interval unless inhibited by a right ventricular sense;

reset the cardiac cycle interval upon either a right ventricular sense or a right ventricular pseudo-pace;

after initiation of post-pace refractory periods for the right and left ventricular sensing channels when the pace is delivered to site LV1, leave the post-pace refractory periods unaffected by the subsequent pace to site LV2.

10. The system of claim 1 wherein the controller is further programmed to:

deliver a left ventricular pace to site LV1 and subsequently deliver a left ventricular pace to site LV2 during a cardiac cycle;

initiate a left ventricular protective period upon delivering a pace to site LV1 during which all further pacing of site LV1 is inhibited;

wherein the left ventricular protective period is unaffected by a pace to site LV2.

11. The system of claim 1 further comprising at least one leadless cardiac pacemaker that includes a controller, one or more sensing channels, and one or more pacing channels.