Electrogram-based control of cardiac resynchronization therapy
First Claim
1. A method for controlling delivery of cardiac resynchronization therapy (CRT) by an implantable medical device of a medical device system, the method comprising:
- by one or more processors of the medical device system;
controlling the implantable medical device to deliver ventricular pacing according to a sequence of different values of at least one of A-V delay or V-V delay;
during the delivery of ventricular pacing according to the sequence, acquiring one or more electrograms, each of the one or more electrograms from a respective one of a plurality of vectors formed by a plurality of electrodes of the medical device system;
for each of the different values of the at least one of A-V delay or V-V delay, determining at least one of a QRS amplitude or a QRS area based on the one or more electrograms;
identifying a target change in QRS amplitude or QRS area between a first value of the sequence of different values of the at least one of A-V delay or V-V delay and a second value of the sequence of different values of the at least one of A-V delay or V-V delay, wherein the second value is one of a next-shortest value or a next-longest value, relative to the first value, of the sequence of different values of the at least one of A-V delay or V-V delay; and
in response to the identification of the target change, controlling the implantable medical device to deliver the ventricular pacing at a value of the at least one of A-V delay or V-V delay determined based on the identification of the target change to provide CRT.
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Accused Products
Abstract
In some examples, controlling delivery of CRT includes delivering ventricular pacing according to a sequence of different values of at least one of A-V delay or V-V delay, and acquiring one or more electrograms from respective vectors. For each of the different values of the at least one of A-V delay or V-V delay, at least one of a QRS amplitude or a QRS area may be determined based on the one or more electrograms, and a target change in QRS amplitude or QRS area between adjacent ones of the values of the at least one of A-V delay or V-V delay of the sequence may be identified. In response to the identification of the target change, the implantable medical device may deliver the ventricular pacing at a value of the at least one of A-V delay or V-V delay determined based on the identification to provide CRT.
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Citations
22 Claims
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1. A method for controlling delivery of cardiac resynchronization therapy (CRT) by an implantable medical device of a medical device system, the method comprising:
by one or more processors of the medical device system; controlling the implantable medical device to deliver ventricular pacing according to a sequence of different values of at least one of A-V delay or V-V delay; during the delivery of ventricular pacing according to the sequence, acquiring one or more electrograms, each of the one or more electrograms from a respective one of a plurality of vectors formed by a plurality of electrodes of the medical device system; for each of the different values of the at least one of A-V delay or V-V delay, determining at least one of a QRS amplitude or a QRS area based on the one or more electrograms; identifying a target change in QRS amplitude or QRS area between a first value of the sequence of different values of the at least one of A-V delay or V-V delay and a second value of the sequence of different values of the at least one of A-V delay or V-V delay, wherein the second value is one of a next-shortest value or a next-longest value, relative to the first value, of the sequence of different values of the at least one of A-V delay or V-V delay; and in response to the identification of the target change, controlling the implantable medical device to deliver the ventricular pacing at a value of the at least one of A-V delay or V-V delay determined based on the identification of the target change to provide CRT. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A medical device system for controlling delivery of cardiac resynchronization therapy (CRT), the system comprising:
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therapy delivery circuitry configured to deliver ventricular pacing to a heart of a patient; sensing circuitry configured to sense electrical activity of the heart via a plurality of electrodes; and one or more processors configured to; control the therapy delivery circuitry to deliver the ventricular pacing according to a sequence of different values of at least one of A-V delay or V-V delay; during the delivery of ventricular pacing according to the sequence, control the sensing circuitry to acquire one or more electrograms, each of the one or more electrograms from a respective one of a plurality of vectors formed by the plurality of electrodes; for each of the different values of the at least one of A-V delay or V-V delay, determine at least one of a QRS amplitude or a QRS area based on the one or more electrograms; identify a target change in QRS amplitude or QRS area between a first value of the sequence of different values of the at least one of A-V delay or V-V delay and a second value of the sequence of different values of the at least one of A-V delay or V-V delay, wherein the second value is one of a next-shortest value or a next-longest value, relative to the first value, of the sequence of different values of the at least one of the A-V delay or the V-V delay; and in response to the identification of the target change, control the therapy delivery circuitry to deliver the ventricular pacing at a value of the at least one of A-V delay or V-V delay determined based on the identification of the target change to provide CRT. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19)
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20. An implantable medical device system for controlling delivery of left-ventricular fusion pacing, the system comprising:
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therapy delivery circuitry configured to deliver left-ventricular pacing to a heart of a patient; sensing circuitry configured to sense electrical activity of the heart via a plurality of implantable electrodes; and one or more processors configured to; control the therapy delivery circuitry to deliver the left-ventricular pacing according to a sequence of different values of A-LV delay; during the delivery of the left-ventricular pacing according to the sequence, control the sensing circuitry to acquire a plurality of electrograms, each of the electrograms from a respective one of a plurality of vectors formed by the plurality of electrodes; determine a vectorcardiogram from the electrograms; for each of the different values of A-LV delay, determine a QRS amplitude based on the vectorcardiogram; identify a decrease in QRS amplitude between adjacent ones of the values of A-LV delay of the sequence, wherein the decrease in QRS amplitude indicates fusion occurring between the right and left ventricles; and in response to the identification of the decrease, control the therapy delivery circuitry to deliver the left-ventricular pacing at the shorter of the adjacent ones of the values of A-LV delay to provide CRT.
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21. A system for controlling delivery of cardiac resynchronization therapy (CRT), the system comprising:
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means for delivering ventricular pacing according to a sequence of different values of at least one of A-V delay or V-V delay; means for, during the delivery of ventricular pacing according to the sequence, acquiring one or more electrograms, each of the one or more electrograms from a respective one of a plurality of vectors formed by a plurality of electrodes of the medical device system; means for, for each of the different values of the at least one of A-V delay or V-V delay, determining at least one of a QRS amplitude or a QRS area based on the one or more electrograms; means for identifying a target change in QRS amplitude or QRS area between a first value of the sequence of different values of the at least one of A-V delay or V-V delay and a second value of the sequence of different values of the at least one of A-V delay or V-V delay, wherein the second value is one of a next-shortest value or a next-longest value, relative to the first value, of the sequence of different values of the at least one of A-V delay or V-V delay; and means for, in response to the identification of the target change, delivering the ventricular pacing at a value of the at least one of A-V delay or V-V delay determined based on the identification of the target change to provide CRT.
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22. A non-transitory computer-readable medium storing instructions for causing a processor of an implantable medical device system to perform a method for controlling delivery of cardiac resynchronization therapy (CRT), the method comprising:
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controlling the implantable medical device to deliver ventricular pacing according to a sequence of different values of at least one of A-V delay or V-V delay; during the delivery of ventricular pacing according to the sequence, acquiring one or more electrograms, each of the one or more electrograms from a respective one of a plurality of vectors formed by a plurality of electrodes of the medical device system; for each of the different values of the at least one of A-V delay or V-V delay, determining at least one of a QRS amplitude or a QRS area based on the one or more electrograms; identifying a target change in QRS amplitude or QRS area between a first value of the sequence of different values of the at least one of A-V delay or V-V delay and a second value of the sequence of different values of the at least one of A-V delay or V-V delay, wherein the second value is one of a next-shortest value or a next-longest value, relative to the first value, of the sequence of different values of the at least one of A-V delay or V-V delay; in response to the identification of the target change, controlling the implantable medical device to deliver the ventricular pacing at a value of the at least one of A-V delay or V-V delay determined based on the identification of the target change to provide CRT.
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Specification