Efficient delivery of multi-site pacing

• US 10,166,396 B2
• Filed: 04/21/2016
• Issued: 01/01/2019
• Est. Priority Date: 04/24/2015
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Schrock, Anthony W, Hudson, Jean E, Kleckner, Karen J
• Primary Examiner(s): Tejani, Ankit D
• Application Number:
  US15/135,288
• Publication Number:
  US 20160339248A1
• Time in Patent Office: 985 Days
• Field of Search: None
• 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 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/36571 controlled by blood flow rate, e.g. blood velocity or cardiac output
• 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
• CPC Class Codes: A61N 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold

Abstract

An implantable device and associated method for delivering multi-site pacing therapy is disclosed. The device comprises a set of electrodes including a first ventricular electrode and a second ventricular electrode, spatially separated from one another and all coupled to an implantable pulse generator. The device comprises a processor configured for selecting a first cathode and a first anode from the set of electrodes to form a first pacing vector at a first pacing site along a heart chamber and selecting a second cathode and a second anode from the set of electrodes to form a second pacing vector at a second pacing site along the same heart chamber. The pulse generator is configured to deliver first pacing pulses to the first pacing vector and delivering second pacing pulses to the second pacing vector. The pulse generator generates a recharging current for recharging a first coupling capacitor over a first recharge time period in response to the first pacing pulses. The pulse generator for generating a recharging current for recharging a second coupling capacitor over a second recharge time period in response to the second pacing pulses. An order of recharging the first and second coupling capacitors is dependent upon one of ventricular pacing mode, left ventricle to right ventricle delay (V-V) pace delay, multiple point LV delay and latest delivered pacing pulses to one of the first and second pacing vectors.

Claims

1. A pacing device comprising a set of electrodes including a first ventricular electrode and a second ventricular electrode, spatially separated from one another and all coupled to an implantable pulse generator, the device comprising:

a processor configured for selecting a first cathode and a first anode from the set of electrodes to form a first pacing vector at a first pacing site along a heart chamber and selecting a second cathode and a second anode from the set of electrodes to form a second pacing vector at a second pacing site along the same heart chamber;

the pulse generator configured to deliver first pacing pulses to the first pacing vector and delivering second pacing pulses to the second pacing vector;

the pulse generator for generating a recharging current for recharging a first coupling capacitor over a first recharge time period in response to the first pacing pulses;

the pulse generator for generating a recharging current for recharging a second coupling capacitor over a second recharge time period in response to the second pacing pulses; and

wherein an order of recharging the first and second coupling capacitors is dependent upon ventricular pacing mode, left ventricle to right ventricle delay, (V-V) pace delay, multiple point LV delay, and latest delivered pacing pulses to one of the first and second pacing vectors.

2. The device of claim 1 wherein the recharging of the first coupling capacitor over the first recharge time period is in response to the first pacing pulses.

3. The device of claim 1 wherein the recharging of the second coupling capacitor over the second recharge time period is in response to the second pacing pulses.

4. The device of claim 1, wherein the first and second recharge time periods are not at a preset time period.

5. The device of claim 4 wherein one of the first and second recharge time periods comprise a set of recharge time periods implemented before recharge is completed for one of the first and second recharge time periods.

6. The device of claim 4 wherein one of the first and second recharge time periods have a same duration in time even if completion of recharge is interrupted by another pace pulse.

7. The device of claim 4, wherein the first and second pacing pulses are configured to be cardiac resynchronization therapy.

8. The device of claim 4, wherein the first pacing site is one of left ventricular tissue and right ventricular tissue.

9. The device of claim 4, wherein the second pacing site being one of left ventricular tissue and right ventricular tissue.

10. The device of claim 4, wherein the first and second pacing sites are spaced apart along left ventricular tissue.

11. The device of claim 1 wherein one of the first and second recharge time periods comprise a set of recharge time periods implemented before recharge is completed for one of the first and second recharge time periods.

12. The device of claim 1 wherein one of the first and second recharge time periods have a same duration in time even if completion of recharge is interrupted by another pace pulse.

13. The device of claim 12, wherein the first and second pacing vectors are the first and the second ventricular electrode.

14. The device of claim 1, wherein the first and second pacing pulses are sequentially spaced apart during the same cardiac cycle.

15. The device of claim 1, wherein the first and second pacing vectors are selected to avoid phrenic nerve stimulation.

16. The device of claim 1, wherein the first and second pacing pulses are configured to be cardiac resynchronization therapy.

17. The device of claim 1, wherein the first pacing site being one of left ventricular tissue and right ventricular tissue.

18. The device of claim 1, wherein the second pacing site being one of left ventricular tissue and right ventricular tissue.

19. The device of claim 1, wherein the first and second pacing site being spaced apart along left ventricular tissue.

20. The device of claim 1, further comprising displaying on a graphical user interface an optimal pacing vector selected from one of the first pacing vector and the second pacing vector.

21. The device of claim 20, wherein an optimal pacing vector configuration comprises the first and the second ventricular electrode that are spaced about 1.5 millimeters apart from each other.

22. A method for controlling a multi-site pacing therapy, the method comprising:

selecting a first cathode and a first anode to form a first pacing vector at a first pacing site along a heart chamber;

selecting a second cathode and a second anode to form a second pacing vector at a second pacing site along a heart chamber;

delivering first pacing pulses to the first pacing vector;

delivering second pacing pulses to the second pacing vector;

recharging a first coupling capacitor over a first recharge time period in response to the first pacing pulses;

recharging a second coupling capacitor over a second recharge time period in response to the second pacing pulses; and

wherein an order of recharging the first and second coupling capacitors is dependent upon ventricular pacing mode, left ventricle to right ventricle delay (V-V) pace delay, multiple point LV delay and latest delivered pacing pulses to one of the first and second pacing vectors.

23. The method of claim 22 wherein the recharging of the first coupling capacitor over the first recharge time period is in response to the first pacing pulses.

24. The method of claim 22 wherein the recharging of the second coupling capacitor over the second recharge time period is in response to the second pacing pulse.

25. The method of claim 22 wherein one of the first and second recharge time periods comprise a set of recharge time periods implemented before recharge is completed for one of the first and second recharge time periods.

26. The method of claim 22 wherein one of the first and second recharge time periods have a same duration in time even though completion of recharge is interrupted by another pace pulse.

27. The method of claim 22, further comprising displaying on a graphical user interface an optimal pacing vector selected from one of the first pacing vector and the second pacing vector.

28. The method of claim 22, wherein an optimal pacing vector configuration comprises a first and a second left ventricular electrode that are spaced about 1.5 millimeters apart from each other.

29. The method of claim 22, wherein the first and second pacing vectors are a first and a second left ventricular electrode.

30. The method of claim 22, wherein the first and second pacing pulses are sequentially spaced apart during the same cardiac cycle.

31. The method of claim 22, wherein the first and second pacing vectors selected to avoid phrenic nerve stimulation.

32. The method of claim 22, wherein the multi-site pacing therapy is configured to be cardiac resynchronization therapy.

33. The method of claim 22 the first pacing site being one of left ventricular tissue and right ventricular tissue.

34. The method of claim 22, the second pacing site being one of left ventricular tissue and right ventricular tissue.

35. The method of claim 22, wherein the first and second recharge time periods are not at a preset time period.

36. The method of claim 35 wherein one of the first and second recharge time periods comprise a set of recharge time periods implemented before recharge is completed for one of the first and second recharge time periods.

37. The method of claim 35 wherein one of the first and second recharge time periods have a same duration in time even though completion of recharge is interrupted by another pace pulse.

38. The method of claim 35, wherein the multi-site pacing therapy is configured to be cardiac resynchronization therapy.

39. The method of claim 35 the first pacing site is one of left ventricular tissue and right ventricular tissue.

40. The method of claim 35, the second pacing site is one of left ventricular tissue and right ventricular tissue.

41. The method of claim 35, wherein the first and second pacing sites are spaced apart along left ventricular tissue.