Determination of cardiac pacing parameters based on non-localized sensing

• US 20080004665A1
• Filed: 06/29/2006
• Published: 01/03/2008
• Est. Priority Date: 06/29/2006
• Status: Abandoned Application

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: McCabe, Aaron R., Yu, Yinghong, Sathaye, Alok S.
• Application Number:
  US11/478,428
• Publication Number:
  US 20080004665A1
• Time in Patent Office: Days
• US Class Current: 607/9
• 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 1/3682 with a variable atrioventricular delay

Abstract

An atrioventricular delay (AVD) for cardiac pacing therapy is determined based, at least in part, on one or more cardiac activation signals sensed using body-implantable electrodes providing non-local sensing. A conduction delay is estimated using a non-local cardiac activation signal and the AVD is determined based on the conduction delay. Estimating the conduction delay may involve measuring a P-wave width or measuring a QRS complex width of the non-local signal. If multiple signals are sensed, the conduction delay may be estimated from a selected signal or may be estimated by forming a representative signal such as through averaging or other methods. The AVD may be determined as a function of the estimated conduction delay.

Claims

1. A method for determining an atrioventricular delay (AVD) for cardiac pacing therapy, comprising:

sensing, using body-implantable electrodes, at least one cardiac activation signal using a cardiac electrode pair providing non-local sensing;

estimating a conduction delay using the at least one non-local cardiac activation signal; and

determining the AVD based on the conduction delay.

2. The method of claim 1, wherein estimating the conduction delay comprises measuring a P-wave width.

3. The method of claim 1, wherein estimating the conduction delay comprises measuring a QRS complex width.

4. The method of claim 1, wherein:

sensing the at least one cardiac activation signal comprises sensing a plurality of cardiac activation signals using a plurality electrode pairs, each electrode pair providing non-local sensing; and

estimating the conduction delay comprises;

selecting a cardiac activation signal of the plurality of cardiac activation signals; and

measuring a feature of the selected cardiac activation signal.

5. The method of claim 1, wherein:

sensing the at least one cardiac activation signal comprises sensing a plurality of cardiac activation signals using a plurality electrode pairs, each electrode pair providing non-local sensing; and

estimating the conduction delay comprises;

selecting at least two cardiac activation signals of the plurality of cardiac activation signals;

combining the at least two cardiac activation signals to form a combined cardiac activation signal; and

measuring a signal feature of the combined cardiac activation signal.

6. The method of claim 1, wherein determining the AVD comprises determining the AVD as a function of the conduction delay.

7. The method of claim 1, wherein determining the AVD comprises determining the AVD as a linear combination of factors including the conduction delay.

8. The method of claim 1, further comprising:

determining an atrial rate associated with the AVD; and

storing the AVD indexed by the atrial rate.

9. The method of claim 1, further comprising delivering cardiac resynchronization therapy using the AVD.

10. The method of claim 1, wherein determining the AVD is performed at least in part by a human analyst.

11. The method of claim 1, wherein determining the AVD is performed at least in part by a processor.

12. The method of claim 1, further comprising:

sensing, using body-implantable electrodes, at least one cardiac activation signal using a cardiac electrode pair providing local sensing; and

determining an additional conduction parameter based on the local signal, wherein determining the AVD comprises determining the AVD using the conduction delay and the additional conduction parameter.

13. A cardiac rhythm management system, comprising:

at least one pair of implantable electrodes configured to electrically couple to a heart and to provide non-local sensing of cardiac electrical activity;

sense circuitry configured to sense at least one cardiac activation signal from the at least one electrode pair; and

a processor configured to estimate a conduction delay based on the at least one cardiac activation signal and to determine an AVD for cardiac pacing therapy based on the conduction delay.

14. The system of claim 13, wherein the pacing therapy comprises biventricular pacing therapy.

15. The system of claim 13, wherein at least one electrode of the electrode pair comprises an intracardiac electrode.

16. The system of claim 13, wherein at least one electrode of the electrode pair comprises a subcutaneous, non-intrathoracic electrode.

17. The system of claim 13, wherein the processor is configured to determine the conduction delay based on a measured feature of the at least one cardiac activation signal.

18. The system of claim 13, wherein the processor is configured to determine a plurality of AVDs, each AVD associated with an atrial rate.

19. The system of claim 13, wherein the processor is patient-external.

20. The system of claim 13, wherein the processor is implantable.

21. The system of claim 13, further comprising one or more additional electrodes, the one or more additional electrodes configured to electrically couple to a heart and to provide local sensing of cardiac electrical activity, wherein the sense circuitry is further configured to sense at least one local cardiac activation signal via the one or more additional electrodes and the processor is configured to estimate an additional conduction parameter based on the local cardiac activation signal and to determine the AVD based on the conduction delay and the additional conduction parameter.

22. A cardiac rhythm management system, comprising:

at least one pair of implantable electrodes configured to electrically couple to a heart and to provide non-local sensing of cardiac electrical activity;

sense circuitry configured to sense at least one cardiac activation signal from the at least one electrode pair;

means for estimating a conduction delay based on the at least one cardiac activation signal; and

means for determining at least one pacing parameter for cardiac pacing therapy based on the conduction delay.

23. The system of claim 22, further comprising:

means for sensing, using body-implantable electrodes, at least one cardiac activation signal using a cardiac electrode pair providing local sensing; and

means for estimating an additional conduction parameter based on the local signal, wherein determining the pacing parameter comprises determining the pacing parameter using the conduction delay and the additional conduction parameter.

24. The system of claim 22, further comprising:

means for determining an atrial rate associated with the AVD; and

means for storing the AVD indexed by the atrial rate.