PACING AND SENSING VECTORS

• US 20070055313A1
• Filed: 10/30/2006
• Published: 03/08/2007
• Est. Priority Date: 02/08/2001
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Tockman, Bruce, Westlund, Randy, Stahmann, Jeffrey, Wentkowski, Rene, Anderson, Russell
• Granted Patent: US 7,945,325 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• 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 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold

Abstract

A method for allowing cardiac signals to be sensed and pacing pulse vectors to be delivered between two or more electrodes. In one embodiment, cardiac signals are sensed and pacing pulse vectors are delivered between least one of a first left ventricular electrode and a second left ventricular electrode. Alternatively, cardiac signals are sensed and pacing pulse vectors are delivered between different combinations of the first and second left ventricular electrodes and a first supraventricular electrode. In addition, cardiac signals are sensed and pacing pulse vectors are delivered between different combinations of the first and second left ventricular electrode, the first supraventricular electrode and a conductive housing. In an additional embodiment, a first right ventricular electrode is used to sense cardiac signals and provide pacing pulses with different combinations of the first and second left ventricular electrodes, the first supraventricular electrode and the housing.

Claims

1. A method, comprising:

programming at least one extended pacing pulse vector between a first supraventricular electrode in a right atrial region and at least one of a first left ventricular electrode and a second left ventricular electrode in a left ventricular region; and

delivering a pacing pulse according to the programmed extended pacing pulse vector between the first supraventricular electrode and at least one of the first left ventricular electrode and the second left ventricular electrode.

2. The method of claim 1, wherein programming at least one extended pacing vector includes programming a first supraventricular electrode in a right atrial region and a commonly connected first left ventricular electrode and second left ventricular electrode.

3. The method of claim 1, wherein programming at least one extended pacing vector includes programming at least one extended pacing vector between the first supraventricular electrode in a right atrial region and at least one of the first left ventricular electrode, the second left ventricular electrode, and a third left ventricular electrode in a left ventricular region, and wherein delivering a pacing pulse includes delivering a pacing pulse according to the programmed extended pacing pulse vector between the first supraventricular electrode and combinations of the first, second, and third left ventricular electrodes.

4. The method of claim 3, further including:

programming a second extended pacing vector including a housing of an implantable pulse generator and at least one of the first left ventricular electrode, the second left ventricular electrode, and a third left ventricular electrode in the left ventricular region; and

delivering a pacing pulse according to the programmed second extended pacing pulse vector.

5. The method of claim 3, further including:

programming a second extended pacing vector including first supraventricular electrode in a right atrial region and a housing of an implantable pulse generator; and

delivering a pacing pulse according to the programmed second extended pacing pulse vector.

6. The method of claim 3, further including:

programming a second extended pacing vector including a connector block electrode of an implantable pulse generator and at least one of the first left ventricular electrode, the second left ventricular electrode, and a third left ventricular electrode in a left ventricular region; and

delivering a pacing pulse according to the programmed second extended pacing pulse vector.

7. The method of claim 3, further including:

programming a second extended pacing vector including first supraventricular electrode in a right atrial region and a connector block electrode of an implantable pulse generator; and

delivering a pacing pulse according to the programmed second extended pacing pulse vector.

8. A method, comprising:

programming at least one extended sensing vector between a first supraventricular electrode in a right atrial region and at least one of a first left ventricular electrode and a second left ventricular electrode in a left ventricular region; and

sensing a cardiac signal between the first supraventricular electrode and at least one of the first left ventricular electrode and the second left ventricular electrode according to the programmed extended sensing vector.

9. The method of claim 8, further including:

programming at least one extended sensing vector between a right ventricular electrode in a right ventricular region and at least one of a first left ventricular electrode and a second left ventricular electrode in a left ventricular region; and

sensing a cardiac signal between the right ventricular electrode and at least one of the first left ventricular electrode and the second left ventricular electrode according to the programmed extended sensing vector.

10. The method of claim 8, further including programming at least one second extended sensing vector between the first supraventricular electrode in a right atrial region and a connector block electrode of an implantable pulse generator;

and

sensing a cardiac signal between the first supraventricular electrode in a right atrial region and connector block electrode of an implantable pulse generator according to the programmed second extended sensing vector.

11. A method, comprising:

programming at least one first extended pacing pulse vector between (1) at least one of a first left ventricular electrode and a second left ventricular electrode in a left ventricular region, and (2) a first supraventricular electrode in a right atrial region;

delivering a pacing pulse according to the first programmed extended pacing pulse vector; and

programming at least one second extended pacing pulse vector between (1) at least one of the first left ventricular electrode and the second left ventricular electrode and (2) a connector block electrode of an implantable pulse generator, and wherein delivering the pacing pulse includes delivering the pacing pulse according to the second programmed extended pacing pulse vector.

12. A method, comprising:

programming at least one first extended pacing pulse vector between (1) at least one of a first left ventricular electrode and a second left ventricular electrode in a left ventricular region, and (2) a first supraventricular electrode in a right atrial region commonly connected to a connector block electrode of an implantable pulse generator;

delivering a pacing pulse according to the first programmed extended pacing pulse vector; and

programming at least one second extended pacing pulse vector between (1) at least one of the first left ventricular electrode and the second left ventricular electrode and (2) a first right ventricular electrode in a right ventricular region, and wherein delivering a pacing pulse includes delivering a pacing pulse according to the second programmed extended pacing pulse vector.

13. A method, comprising:

programming at least one first extended pacing pulse vector between (1) at least one of a first left ventricular electrode and a second left ventricular electrode in a left ventricular region, and (2) a right ventricular electrode in a right ventricular region;

delivering a pacing pulse according to the programmed first extended pacing pulse vector; and

programming at least one second extended pacing pulse vector between (1) at least one of the first left ventricular electrode and the second left ventricular electrode, and (2) a supraventricular electrode in a right atrial region commonly connected to a connector block electrode of an implantable pulse generator, and wherein delivering a pacing pulse includes delivering a pacing pulse according to the programmed second extended pacing pulse vector.

14. A method, comprising:

programming at least one first extended pacing pulse vector between (1) at least one of a first left ventricular electrode commonly connected to a second left ventricular electrode in a left ventricular region, and (2) a right ventricular electrode in a right ventricular region;

delivering a pacing pulse according to the programmed first extended pacing pulse vector;

programming at least one second extended pacing pulse vector between (1) the first and second commonly connected left ventricular electrodes, and (2) a commonly connected supraventricular electrode in a right atrial region and a connector block electrode of an implantable pulse generator; and

delivering a pacing pulse according to the programmed second extended pacing pulse vector.

15. A method, comprising:

programming at least one extended pacing pulse vector between a first right ventricular electrode in a right ventricular region and at least one of a first left ventricular electrode and a second left ventricular electrode in a left ventricular region; and

delivering a pacing pulse between the first left ventricular electrode and the second left ventricular electrode and the first right ventricular electrode and a connector block electrode of an implantable pulse generator, where the first and second left ventricular electrodes are common and the first right ventricular electrode and the connector block electrode are common.

16. A method comprising:

disposing a first electrode in association with a left ventricular region of a heart;

disposing a second electrode in association with a right atrial region of the heart;

delivering a first pacing pulse between the first and second electrodes;

disposing a connector block electrode of an implantable pulse generator in association with the heart;

delivering a second pacing pulse between the first electrode and the connector block electrode of the implantable pulse generator;

disposing a third electrode in association with the left ventricular region;

coupling the third electrode electrically in common with the first electrode; and

wherein the delivering the second pacing pulse includes delivering the second pacing pulse between (1) the commonly-connected first and third electrodes and (2) the connector block electrode of the implantable pulse generator.

17. A method comprising:

disposing a first electrode in association with a left ventricular region of a heart;

disposing a second electrode in association with a right ventricular region of the heart;

disposing a connector block electrode of an implantable pulse generator in association with the heart;

delivering a first pacing pulse between the first and second electrodes;

disposing a third electrode in association with the left ventricular region;

coupling the third electrode electrically in common with the first electrode, wherein the delivering the first pacing pulse includes delivering the pacing pulse between;

(1) the commonly connected first and third electrodes; and

(2) the second electrode; and

delivering a second pacing pulse between the first electrode and the connector block electrode of the implantable pulse generator.

18. The method of claim 17, wherein the delivering the second pacing pulse includes delivering the second pacing pulse between (1) the commonly-connected first and third electrodes and (2) the connector block electrode of the implantable pulse generator.

19. A method comprising:

disposing a first electrode in association with a left ventricular region of a heart;

disposing a second electrode in association with a right atrial region of the heart;

delivering a first pacing pulse between the first and second electrodes;

disposing a connector block electrode of an implantable pulse generator in association with the heart; and

delivering a second pacing pulse between the first electrode and the connector block electrode of the implantable pulse generator.

20. The method of claim 19, further comprising:

disposing a third electrode in association with the left ventricular region;

coupling the third electrode electrically in common with the first electrode; and

wherein the delivering the second pacing pulse includes delivering the second pacing pulse between (1) the commonly-connected first and third electrodes and (2) the connector block electrode of the implantable pulse generator.

21. A method comprising:

disposing first and second right ventricular electrodes in a right ventricular region;

disposing first and second left ventricular electrodes in a left ventricular region; and

programming at least one extended pacing pulse vector between commonly connected first and second right ventricular electrodes and at least one of the first left ventricular electrode or the second left ventricular electrode.

22. A method comprising:

disposing an anodic first electrode within a ventricle at or near an apex of the ventricle;

disposing a cathodic second electrode in association with the ventricle at a location that is more proximal than the first electrode; and

delivering a pacing level pulse between the anodic first electrode and the cathodic second electrode.

23. The method of claim 22, wherein the disposing the cathodic second electrode includes disposing a defibrillation electrode.

24. The method of claim 23, the disposing the cathodic second electrode includes positioning the first ventricular electrode in a right ventricular region, and wherein disposing the anodic first electrode includes positioning the first pacing/sensing electrode at or near an apex of the right ventricular region.