Local and non-local sensing for cardiac pacing

• US 20080009909A1
• Filed: 06/29/2006
• Published: 01/10/2008
• Est. Priority Date: 06/29/2006
• Status: Active Grant

• 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.
• Granted Patent: US 8,527,048 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• 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 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

Systems and methods for determining pacing timing intervals based on the temporal relationship between the timing of local and non-local cardiac signal features are described. A device includes a plurality of implantable electrodes electrically coupled to the heart and configured to sense local and non-local cardiac signals. Sense circuitry coupled to first and second electrode pairs senses a local cardiac signal via a first electrode pair and a non-local cardiac signal via a second electrode pair. Detection circuitry is used to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber. A control processor times delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature.

Claims

1. A method for delivery of pacing therapy, comprising:

sensing, using body-implantable electrodes, at least one local cardiac electrical signal and at least one non-local cardiac electrical signal;

sensing for a feature of the local signal corresponding to activation of a heart chamber;

sensing for a feature of the non-local signal corresponding to the activation of the heart chamber; and

timing delivery of one or more pacing pulses based on a temporal relationship between timing of the feature of the local signal and timing of the feature of the non-local signal.

2. The method of claim 1, wherein:

sensing the local signal comprises sensing, for a cardiac cycle, the local signal;

sensing the non-local signal comprises sensing, for the cardiac cycle, the non-local signal; and

timing delivery of the pacing pulses comprises timing delivery of the pacing pulses for the cardiac cycle.

3. The method of claim 1, wherein timing delivery of the pacing pulses comprises determining an atrioventricular delay based on the temporal relationship between the local feature timing and the non-local feature timing.

4. The method of claim 1, wherein:

sensing the local cardiac signal comprises sensing from a local atrial site;

sensing for the local signal feature comprises sensing for a local P-wave;

sensing for the non-local signal feature comprises sensing for a non-local P-wave; and

timing the delivery of the pacing pulses comprises determining an atrioventricular delay based on the temporal relationship between the local P-wave and the non-local P-wave.

5. The method of claim 1, wherein:

sensing the local cardiac signal comprises sensing from a local atrial site;

sensing for the local signal feature comprises sensing for a local P-wave;

sensing for the non-local signal feature comprises sensing for a non-local P-wave; and

timing the delivery of the pacing pulses comprises;

initiating an atrioventricular delay based on the detection of the local P-wave; and

ending the atrioventricular delay based on the detection of the non-local P-wave.

6. The method of claim 1, wherein timing the delivery of the pacing pulses comprises:

triggering delivery of a pacing pulse if the non-local feature is detected; and

triggering delivery of the pacing pulse based on the local feature if the non-local feature is not detected.

7. The method of claim 6, wherein:

triggering delivery of the pacing pulse if the non-local feature is detected comprises triggering delivery of an atrial pacing pulse if a non-local P-wave is detected; and

triggering deliver of the pacing pulse comprises triggering deliver of the atrial pacing pulse based on a local P-wave.

8. The method of claim 6, wherein:

triggering delivery of the pacing pulse if the non-local feature is detected comprises triggering delivery of a ventricular pacing pulse if a non-local QRS complex is detected; and

triggering delivery of the pacing pulse based on the local feature comprises triggering delivery of the ventricular pacing pulse based on a local QRS complex if the non-local QRS complex is not detected.

9. An implantable cardiac rhythm management device, comprising:

a plurality of implantable electrodes electrically coupled to the heart, at least a first pair of the plurality of electrodes configured to sense a local cardiac signal and at least a second pair of the plurality of electrodes configured to sense a non-local cardiac signal;

sense circuitry coupled to the first and second electrode pairs and configured to sense a local cardiac signal via the first electrode pair and a non-local cardiac signal via the second electrode pair;

detection circuitry configured to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber; and

a control processor configured to time delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature.

10. The device of claim 9, wherein at least one electrode of the second pair of electrodes comprises a ring electrode.

11. The device of claim 9, wherein at least one electrode of the second pair of electrodes comprises a defibrillation coil.

12. The device of claim 9, wherein the at least one electrode of the second pair of electrodes comprises a subcutaneous, non-intrathoracic electrode.

13. The device of claim 9, wherein:

the local signal feature comprises a local P-wave;

the non-local signal feature of the comprises a non-local P-wave; and

the control processor is configured determine an atrioventricular delay based on the temporal relationship between the timing of the local P-wave and the timing of the non-local P-wave, the atrioventricular delay used to time delivery of the one or more pacing pulses.

14. The device of claim 13, wherein the control processor is configured to determine the atrioventricular delay based on the temporal relationship between a beginning, end, or peak timing of the local P-wave and a beginning, end, or peak timing of the non-local P-wave.

15. The device of claim 9, wherein the control processor is configured to trigger pacing based on the timing of the non-local signal feature if the non-local signal feature is detected and to trigger pacing based on the timing of the local signal feature if the non-local signal feature is not detected.

16. The device of claim 9, wherein delivery of the pacing pulses comprises delivery of an atrioventricular synchronous pacing therapy.

17. The method of claim 9, wherein delivery of the pacing pulses comprises delivery of a bradycardia pacing therapy.

18. The method of claim 9, wherein the deliver of the pacing pulses comprises delivery of a resynchronization pacing therapy.

19. A system for delivery of pacing therapy, comprising:

a first pair of body-implantable electrodes configured to sense a local cardiac signal;

a second pair of body-implantable electrodes configured to sense a non-local cardiac signal;

means for detecting a feature of the local signal related to activation of a cardiac chamber;

means for detecting a feature of the non-local signal related to activation of the cardiac chamber; and

means for timing delivery of one or more pacing pulses based a temporal relationship between timing of the local feature and timing of the non-local feature.

20. The system of claim 19, further comprising means for determining an atrioventricular delay based on the temporal relationship.

21. The system of claim 19, further comprising means for implementing triggered pacing based on the temporal relationship between the timing of the local signal feature and the timing of the non-local signal feature.