SWITCH POLARITY PACING TO IMPROVE CARDIAC RESYNCHRONIZATION THERAPY

• US 20090240298A1
• Filed: 10/21/2008
• Published: 09/24/2009
• Est. Priority Date: 03/18/2008
• Status: Active Grant

• Current Assignee: Biotronik SE & Company KG
• Original Assignee: Biotronik CRM Patent AG (Biotronik SE & Company KG)
• Inventors: Lang, Volker, Muessig, Dirk, Garner, Garth, LIAN, Jie
• Granted Patent: US 8,380,307 B2
• 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 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD

Abstract

The invention is directed to a heart stimulator for left-ventricular pacing comprising a left ventricular stimulation pulse generator connected or connectable to a single electrode lead for left ventricular stimulation having one or more electrodes for delivery of stimulation pulses to left ventricular myocardial heart tissue, said stimulation pulse generator being adapted to generate and deliver stimulation pulses of switchable polarity. The heart stimulator further comprises a control unit connected to the stimulation pulse generator for controlling the stimulation pulse generator and to trigger generation and delivery of stimulation pulses having a polarity controlled by said control unit, wherein the control unit is adapted to control said left ventricular stimulation pulse generator so as to deliver at least a pair of suprathreshold stimulation pulses of opposite polarity.

Claims

1. A heart stimulator for left-ventricular pacing comprising:

a left ventricular stimulation pulse generator connected or connectable to a single left ventricular electrode lead adapted to be placed for left ventricular stimulation and having one or more electrodes for delivery of stimulation pulses to left ventricular myocardial heart tissue, said left ventricular stimulation pulse generator adapted to generate and deliver stimulation pulses of switchable polarity; and

,

a control unit connected to said left ventricular stimulation pulse generator and adapted to control said left ventricular stimulation pulse generator to

trigger generation and delivery of stimulation pulses having a polarity controlled by said control unit, and to

deliver at least a pair of supra-threshold stimulation pulses of opposite polarity.

2. The heart stimulator of claim 1, wherein the control unit is adapted to control said left ventricular stimulation pulse generator so as to first deliver at least one anodal stimulation pulse via an electrode on said single left ventricular electrode lead and to deliver a cathodal stimulation pulse via an electrode on said single left ventricular electrode lead immediately following the at least one anodal stimulation pulse.

3. The heart stimulator of claim 1 wherein said single left ventricular electrode lead comprises a left ventricular tip electrode and said control unit is adapted to select said left ventricular tip electrode as anode for anodal pacing.

4. The heart stimulator of claim 1 wherein said single left ventricular electrode lead comprises a left ventricular ring electrode and said control unit is adapted to select said left ventricular ring electrode as anode for anodal pacing.

5. The heart stimulator of claim 1,

wherein said single left ventricular electrode lead comprises a left ventricular tip electrode and said control unit is adapted to select said left ventricular tip electrode as anode for anodal pacing;

wherein said single left ventricular electrode lead comprises a left ventricular ring electrode and said control unit is adapted to select said left ventricular ring electrode as anode for anodal pacing; and

,

wherein said heart stimulator comprises or is connected to further electrodes other than said left ventricular tip electrode or said left ventricular ring electrode, and said control unit is adapted to select one of said further electrode as cathode for anodal pacing.

6. The heart stimulator of claim 5, wherein said one of said further electrodes acting as cathode for anodal pacing can be one of:

an electrically conducting part of a heart stimulator'"'"'s housing, a coil electrode adapted for placement in a superior vena cava (SVC), a coil electrode adapted for placement in a right ventricle, or a combination of said coil electrode adapted for placement in the superior vena cava (SVC) and said coil electrode adapted for placement in the right ventricle.

7. The heart stimulator according to claim 3 wherein said control unit is adapted to control said left ventricular stimulation pulse generator so as to deliver an anodal stimulation pulse having a strength that is selected so that the anodal pacing alone results in left ventricular capture, whereas the anodal pacing does not result in cathodal capture of a right ventricle or phrenic nerve stimulation.

8. The heart stimulator according to claim 1 wherein said single left ventricular electrode lead comprises a left ventricular ring electrode and said control unit is adapted to select said left ventricular ring electrode as cathode for cathodal pacing.

9. The heart stimulator according to claim 1 wherein said single left ventricular electrode lead comprises a left ventricular tip electrode and said control unit is adapted to select said left ventricular tip electrode as cathode for cathodal pacing.

10. The heart stimulator of claim 1,

wherein said single left ventricular electrode lead comprises a left ventricular ring electrode and said control unit is adapted to select said left ventricular ring electrode as cathode for cathodal pacing;

wherein said single left ventricular electrode lead comprises a left ventricular tip electrode and said control unit is adapted to select said left ventricular tip electrode as cathode for cathodal pacing; and

,

wherein said heart stimulator comprises or is connected to further electrodes other than said left ventricular tip electrode or said left ventricular ring electrode, and said control unit is adapted to select one of said further electrode as anode for cathodal pacing.

11. The heart stimulator of claim 10, wherein said one of said further electrodes acting as anode for cathodal pacing can be one of:

an electrically conducting part of a heart stimulator'"'"'s housing, a coil electrode adapted for placement in a superior vena cava (SVC), a coil electrode adapted for placement in a right ventricle, or a combination of said coil electrode adapted for placement in the superior vena cava (SVC) and said coil electrode adapted for placement in the right ventricle.

12. The heart stimulator according to claim 8 wherein said control unit is adapted to control said left ventricular stimulation pulse generator so as to deliver a cathodal stimulation pulse having a strength that is selected so that the cathodal pacing alone results in left ventricular capture, whereas the cathodal pacing does not result in anodal capture of the right ventricle or phrenic nerve stimulation.

13. The heart stimulator according to claim 1 wherein said control unit is adapted to control said left ventricular stimulation pulse generator so as to first deliver more than one anodal stimulation pulse via at least one electrode on said single left ventricular electrode lead and to deliver a cathodal stimulation pulse via an electrode on said single left ventricular electrode lead immediately following a last anodal stimulation pulse.

14. The heart stimulator of claim 13, wherein said control unit is adapted to control said left ventricular stimulation pulse generator so as to deliver the more than one anodal stimulation pulse wherein a second anodal stimulation pulse is delivered via an electrode configuration different from the electrode configuration used for delivery of a first anodal stimulation pulse.

15. The heart stimulator of claim 13, wherein said control unit is adapted to control said left ventricular stimulation pulse generator so that the first anodal stimulation pulse is delivered between a left ventricular ring electrode acting as anode and a right ventricular coil electrode acting as cathode, the second anodal stimulation pulse is delivered between a left ventricular tip electrode acting as anode and an electrically conducting housing of a heart stimulator acting as cathode, and a following cathodal stimulation pulse is delivered between the left ventricular tip electrode acting as cathode and the left ventricular ring electrode acting as anode.

16. A method for stimulating a left ventricle of a heart with electric stimulation pulses comprising:

delivering of a first anodal stimulation pulse to a left ventricular myocardium; and

,

following immediately said delivering of said first anodal stimulation pulse with a delivering of a second cathodal stimulation pulse to the left ventricular myocardium, wherein said anodal stimulation pulse and said cathodal stimulation pulse both have supra-threshold stimulation strength that is sufficient to cause capture of the myocardium.