Selection of cardiac capture verification modes

• US 20070118181A1
• Filed: 11/21/2005
• Published: 05/24/2007
• Est. Priority Date: 11/21/2005
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Sathaye, Alok
• Granted Patent: US 7,778,696 B2
• Time in Patent Office: Days
• US Class Current: 607/28
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold

Abstract

Systems and methods provide for selection of automatic capture verification modes. A number of capture verification modes are evaluated, wherein at least one of the capture verification modes has a distinct temporal relationship between delivery of a pacing pulse and detection of capture of heart tissue by the pacing pulse than the other capture verification modes. One or more capture verification modes are selected based on the evaluation. Capture verification is implemented using the selected one or more capture verification modes.

Claims

1. A method for automatically implementing capture verification in a cardiac rhythm management system, comprising:

evaluating a plurality of capture verification modes, at least one capture verification mode of the plurality of capture verification modes having a distinct temporal relationship between delivery of a pacing pulse and detection of capture of heart tissue by the pacing pulse than other capture verification modes of the plurality of capture verification modes;

selecting one or more capture verification modes based on the evaluation; and

implementing capture verification using the selected one or more capture verification modes.

2. The method of claim 1, wherein the at least one capture verification mode comprises a single chamber capture verification mode.

3. The method of claim 1, wherein at the least one capture verification mode comprises a multi-chamber capture verification mode.

4. The method of claim 1, wherein the at least one capture verification mode uses a different capture detection algorithm or a different sensing vector than the other capture verification modes.

5. The method of claim 1, wherein the at least one capture verification mode uses a same sensing vector for detecting capture as the other capture verification modes.

6. The method of claim 1, wherein the at least one capture verification mode uses a same capture detection algorithm for detecting capture as the other capture verification modes.

7. The method of claim 1, wherein the at least one capture verification mode uses a sensing vector for detecting capture that is spatially more distal from the pacing vector than a sensing vector used for detecting capture by the other capture verification modes.

8. The method of claim 1, wherein evaluating the plurality of capture verification modes comprises evaluating the plurality of capture verification modes during a capture threshold test.

9. The method of claim 1, wherein evaluating the plurality of capture verification modes on a beat by beat basis.

10. The method of claim 1, wherein evaluating the plurality of capture verification modes comprises sensing for capture using each of the plurality of capture verification modes based on cardiac signals of one cardiac cycle.

11. The method of claim 1, wherein evaluating the plurality of capture verification modes comprises sensing for capture using each of the plurality of capture verification modes based on cardiac signals of multiple cardiac cycles.

12. The method of claim 1, wherein selecting the one or more capture verification modes comprises selecting the one or more capture verification modes based at least in part on capture detection reliability of the selected one or more capture verification modes.

13. The method of claim 1, wherein selecting the one or more capture verification modes comprises selecting the one or more capture verification modes based at least in part on a hierarchy of capture verification modes.

14. The method of claim 1, wherein selecting the one or more capture verification modes comprises selecting the one or more capture verification modes based at least in part on a temporal proximity of capture detection of the one or more capture verification modes to the timing of the pacing pulse.

15. The method of claim 1, wherein:

selecting the one or more capture verification modes comprises selecting multiple capture verification modes; and

implementing capture verification comprises implementing capture verification using a combination of the multiple capture verification modes.

16. The method of claim 1, wherein:

selecting the one or more capture verification modes comprises selecting a first capture verification mode and a second capture verification mode; and

implementing capture verification comprises using the second capture verification mode to confirm the first capture verification mode.

17. The method of claim 1, further comprising periodically re-evaluating the plurality of capture verification modes.

18. The method of claim 1, further comprising re-evaluating the plurality of capture verification modes responsive to an event that may alter capture verification effectiveness.

19. A cardiac capture verification system, comprising:

a sensing circuitry configured to sense cardiac response signals to a pacing pulse associated with capture verification modes;

capture detection circuitry coupled to the sensing system and configured to analyze the cardiac response signals to detect capture in accordance with the plurality of capture verification modes, the capture verification modes including at least one capture verification mode of the plurality of capture verification modes having a distinct temporal relationship between delivery of a pacing pulse and detection of capture of heart tissue by the pacing pulse than other capture verification modes of the plurality of capture verification modes;

a processor coupled to the capture detection circuitry, the processor configured to evaluate the plurality of capture verification modes and to select one or more capture verification modes for implementation based on the evaluation.

20. The system of claim 19, wherein the sensing circuitry comprises:

a first electrode configured to sense a first cardiac response signal used for capture detection in a first capture verification mode; and

a second electrode configured to sense a second cardiac response signal used for capture detection in a second capture verification mode, the first electrode spatially more distant from a pacing electrode than the second electrode.

21. The system of claim 19, wherein the sensing circuitry comprises a pacing electrode and at least one of the cardiac response signals is sensed using the pacing electrode.

22. The system of claim 19, wherein the sensing circuitry comprises a defibrillation coil and at least one of the cardiac response signals is sensed using the defibrillation coil.

23. The system of claim 19, wherein at least one of the cardiac response signals comprises a wireless ECG signal.

24. The system of claim 19, wherein at least one of the cardiac response signals comprises a surface ECG signal.

25. The system of claim 19, wherein at least one of the cardiac response signals comprises a T-wave signal.

26. The system of claim 19, wherein the processor is configured to evaluate the plurality of capture verification modes using the plurality of cardiac response signals sensed during one cardiac cycle.

27. The system of claim 19, wherein the processor is configured to evaluate the plurality of capture verification modes using the plurality of cardiac response signals sensed during a sequence of cardiac cycles.

28. The system of claim 19, wherein the processor is configure to select the one or more capture verification modes based at least in part on a temporal proximity of capture detection determined by the one or more capture verification modes to the timing of the pacing pulse.

29. The system of claim 19, further comprising a memory configured to store a hierarchy of capture verification modes and wherein the processor is configured to select the one or more capture verification modes based at least in part on the stored hierarchy of capture verification modes.

30. The system of claim 19, wherein the processor is configured to select multiple capture verification modes for implementation as a combination of the multiple capture verification modes.

31. The system of claim 19, wherein the processor is configured to select a first capture verification mode and a second capture verification mode and wherein the second capture verification mode is implemented to confirm the first capture verification mode.

32. The system of claim 19, wherein the processor is configured to re-evaluate the plurality of capture verification modes responsive to an event that may alter capture verification effectiveness.

33. A system for automatically implementing capture verification in a cardiac rhythm management system, comprising:

means for evaluating a plurality of capture verification modes, at least one capture verification mode of the plurality of capture verification modes having a distinct temporal relationship between delivery of a pacing pulse and detection of capture of heart tissue by the pacing pulse than other capture verification modes of the plurality of capture verification modes;

means for selecting one or more capture verification modes based on the evaluation; and

means for implementing capture verification using the selected one or more capture verification modes.

34. The system of claim 33, further comprising means for detecting capture using each of the plurality of capture verification modes based on cardiac signals sensed during one cardiac cycle.

35. The system of claim 33, further comprising means for detecting capture using each of the plurality of capture verification modes based on cardiac signals sensed during multiple cardiac cycles.

36. The system of claim 33, further comprising means for selecting the one or more capture verification modes based on a hierarchy of capture verification modes.

37. The system of claim 33, further comprising means for selecting the one or more capture verification modes based on a temporal proximity of capture detection of the one or more capture verification modes to the timing of the pacing pulse.