Capture management in multi-site pacing
First Claim
1. A method for delivering therapy to a heart, comprising:
- providing a plurality of electrodes in or around the heart;
delivering an electrical stimulus to the heart;
measuring a polarization potential vector between at least a first pair of electrodes of the plurality of electrodes and a second pair of electrodes of the plurality of electrodes;
comparing the polarization potential vector between at least the first pair of electrodes and the second pair of electrodes; and
selecting a sensing pair of electrodes from at least the first pair of electrodes and the second pair of electrodes that yields the lowest polarization potential vector, the sensing pair of electrodes operable for use in sensing an evoked response of the heart to a subsequent electric stimulus delivered thereto.
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Accused Products
Abstract
Methods and apparatus for capture management in multi-chamber pacing are disclosed. In one embodiment, the invention includes determining a combination of electrodes from a plurality of electrodes that yields the lowest polarization potential immediately following delivery of an electrical stimulus to a heart; and performing capture detection using that combination of electrodes. In order to distinguish loss of capture in one ventricle in bi-ventricular pacing, certain embodiments may also include measuring a width of a QRS complex and determining when the width is greater than a predetermined value. A method for detecting single ventricular loss of capture in bi-ventricular pacing is also described utilizing comparison of evoked QRS complex morphology to a predefined waveform.
73 Citations
38 Claims
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1. A method for delivering therapy to a heart, comprising:
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providing a plurality of electrodes in or around the heart;
delivering an electrical stimulus to the heart;
measuring a polarization potential vector between at least a first pair of electrodes of the plurality of electrodes and a second pair of electrodes of the plurality of electrodes;
comparing the polarization potential vector between at least the first pair of electrodes and the second pair of electrodes; and
selecting a sensing pair of electrodes from at least the first pair of electrodes and the second pair of electrodes that yields the lowest polarization potential vector, the sensing pair of electrodes operable for use in sensing an evoked response of the heart to a subsequent electric stimulus delivered thereto. - View Dependent Claims (2, 3, 4, 5, 6)
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7. A method for delivering therapy to a heart using an implantable medical device, comprising:
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implanting a first lead of the implantable medical device proximate a right ventricle of the heart, the first lead having at least one electrode associated therewith;
implanting a second lead of the implantable medical device proximate a right atrium of the heart, the second lead having at least one electrode associated therewith;
implanting a third lead of the implantable medical device through a left lateral coronary vein of the heart proximate a left ventricle of the heart, the third lead having at least one electrode associated therewith;
delivering an electrical stimulus to at least one chamber of the heart;
measuring a polarization potential vector between each of a plurality of combinations of electrodes associated with the first lead, the second lead, the third lead, and a housing of the implantable medical device;
comparing the measured polarization potential vector of each of the plurality of combinations of electrodes; and
selecting a combination of electrodes that yields the lowest measured polarization potential vector for the at least one chamber of the heart, wherein the selected combination of electrodes is operable for sensing an evoked response to a subsequent electric stimulus delivered to the at least one chamber of the heart. - View Dependent Claims (8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A method of pacing one or both of a right atrium and a left atrium of a heart, comprising:
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providing an implantable medical device having at least a first lead and a second lead, wherein the first lead comprises a first electrode at or near its distal end and the second lead comprises a second electrode at or near its distal end;
locating the first electrode proximate a right atrium of the heart;
locating the second electrode proximate a left side of the heart;
delivering an atrial pacing pulse to one or both of the right atrium and the left atrium; and
detecting an evoked response of one or both of the right atrium and the left atrium by measuring an electrical potential vector between the first electrode and the second electrode. - View Dependent Claims (19, 20, 21, 22, 23, 24, 25, 26)
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27. An implantable medical device operable for pacing one or both of a right atrium and a left atrium of a heart, comprising:
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a housing;
an atrial pulse generator located within the housing;
logic and control circuitry located within the housing and operable to control the atrial pulse generator;
a first lead extending from the housing and having a first electrode at or near its distal end, the first electrode locatable proximate a right atrium of the heart;
a second lead extending from the housing and having a second electrode at or near its distal end, the second electrode locatable proximate a left side of the heart; and
sensor circuitry operable to sense an evoked response of the heart between the first electrode and the second electrode. - View Dependent Claims (28)
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29. A method for bi-ventricular pacing of a heart using an implantable medical device, the method comprising:
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delivering a first electrical stimulus to a right ventricle;
measuring a width of a first QRS complex;
detecting that the width of the first QRS complex is greater than a first predetermined width;
setting a magnitude of a first electrical output stimulus to the right ventricle;
delivering a second electrical stimulus to a left ventricle;
measuring a width of a second QRS complex;
detecting that the width of the second QRS complex is greater than a second predetermined width; and
setting a magnitude of a second electrical output stimulus to the left ventricle. - View Dependent Claims (30, 31, 32, 33)
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34. A method for pacing a ventricle of a heart using an implantable medical device, the method comprising:
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selecting a combination of sensing electrodes from a plurality of electrodes that yields a lowest polarization potential vector in response to an electrical stimulus to the ventricle;
delivering a pacing pulse to the ventricle;
measuring one or more parameters of a QRS complex using the selected combination of sensing electrodes; and
detecting capture of the ventricle in response to the pacing pulse by comparing the one or more parameters of the QRS complex to one or more predetermined values. - View Dependent Claims (35, 36, 37, 38)
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Specification