EXTRA-CARDIAC IMPLANTABLE DEVICE WITH FUSION PACING CAPABILITY

• US 20090275999A1
• Filed: 04/30/2008
• Published: 11/05/2009
• Est. Priority Date: 04/30/2008
• Status: Abandoned Application

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Dolan, Becky L., Burnes, John E.
• Application Number:
  US12/112,833
• Publication Number:
  US 20090275999A1
• Time in Patent Office: Days
• US Class Current: 607/25
• CPC Class Codes: A61N 1/0587 Epicardial electrode systems; Endocardial electrodes piercing the pericardium
• 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

Abstract

According to this disclosure, a non-transvenous pacing and, optionally defibrillation, therapy device is implanted subcutaneously and oriented to provide cardiac sensing from electrodes spaced from a heart and deliver pacing and/or defibrillation from one or more non-transvenous electrodes (e.g., an epicardial or pericardial electrode or electrode patch). A subject receiving a device according to this disclosure is monitored to confirm a relatively stable bundle branch block (i.e., delayed activation) of one ventricle. The subcutaneous device has electrodes disposed on the housing and/or having an electrode on a subcutaneous medical lead is oriented so that the pacing (and sensing) vector impinges mainly upon the one ventricle, and/or optionally an epicardial or pericardial lead is deployed to a last-to-depolarize ventricle (e.g., a left ventricle) so that single-ventricular pacing is delivered to achieve fusion depolarization of both ventricles.

Claims

1. A method of delivering a single-ventricular fusion-type pacing therapy that mimics the effect of successful delivery of cardiac resynchronization therapy via a non-transvenous cardiac therapy device, comprising:

a) detecting a P-wave accompanying an atrial depolarization during a cardiac cycle from a far-field sensing array coupled to an extra-cardiac implantable medical device (EC-IMD) spaced from the myocardium;

b) detecting an intrinsic ventricular depolarization (an R-wave) during the cardiac cycle;

c) measuring the time elapsed between the detected P-wave and the detected R-wave (a P-R interval);

d) decrementing the P-R interval by a predetermined amount as a fusion AV (FAV) interval; and

e) delivering a single pacing stimulus to a left ventricle via a non-transvenous electrode coupled to the myocardium at the expiration of the FAV interval.

2. A method according to claim 1, wherein the decremented P-R interval includes a pre-excitation interval (PEI) component.

3. A method according to claim 2, wherein the PEI comprises an interval of between about 10 milliseconds (ms) and about 50 ms.

4. A method according to claim 1, wherein the electrode comprises one of an epicardial patch-type assembly and a pericardial electrode.

5. A method according to claim 1, wherein the electrode comprises a helical screw-type electrode.

6. A method according to claim 1, wherein detecting the R-wave comprises sensing the R-wave from a vector that includes the far-field sensing array.

7. A method according to claim 4, wherein detecting the R-wave comprises sensing the R-wave from a vector that includes one of the epicardial patch-type assembly and the pericardial electrode.

8. A method according to claim 5, wherein detecting the R-wave comprises sensing the R-wave from a vector that includes the helical screw-type electrode.

9. A method according to claim 1, further comprising repeating steps a)-e).

10. A method according to claim 1, further comprising:

detecting an arrhythmia via one of the far-field sensing array, an epicardial patch-type assembly, a pericardial electrode, and a helical screw-type electrode;

ceasing delivery of the single-ventricular fusion-pacing therapy; and

delivering one of an anti-tachycardia pacing sequence and a defibrillation therapy via one of the epicardial patch-type assembly, the pericardial electrode, the helical screw-type electrode, and a high voltage defibrillation coil coupled to the EC-IMD cardiac therapy device.

11. A method according to claim 10, wherein the arrhythmia comprises one of an atrial arrhythmia and a ventricular arrhythmia.

12. A method according to claim 11, further comprising—

upon detection of a termination of said arrhythmia—

performing steps a)-e).

14. An apparatus according to claim 12, wherein the means for decrementing the P-R interval includes means for decrementing the P-R interval by a predetermined pre-excitation interval (PEI) component.

15. An apparatus according to claim 14, wherein the predetermined PEI component comprises an interval of between about 10 milliseconds (ms) and about 50 ms.

13. An apparatus for establishing a fusion atrio-ventricular (FAV) pacing delay interval for a non-transvenous cardiac therapy device, comprising:

a) means for detecting a P-wave accompanying an atrial depolarization during a cardiac cycle from a far-field sensing array directly coupled to an implantable medical device spaced from the myocardium;

b) means for detecting an intrinsic ventricular depolarization (an R-wave) during the cardiac cycle;

c) means for measuring the time elapsed between the detected P-wave and the detected R-wave (a P-R interval);

d) means for decrementing the P-R interval by a predetermined amount as a fusion AV (FAV) interval; and

e) means for delivering a single pacing stimulus to a left ventricle via an electrode coupled to one of the epicardium and the pericardium at the expiration of the FAV interval.

16. An apparatus according to claim 13, wherein the electrode comprises one of an epicardial patch-type assembly, a pericardial electrode, a helical screw-type electrode.

17. An apparatus according to claim 13, wherein the means for detecting the R-wave includes means for sensing the R-wave from a vector that includes one of the far-field sensing array, an epicardial patch-type assembly, a pericardial electrode, a helical screw-type electrode.

18. An apparatus according to claim 17, further comprising:

means for detecting an arrhythmia via one of the far-field sensing array, the epicardial patch-type assembly, the pericardial electrode, and the helical screw-type electrode;

means for ceasing delivery of the single-ventricular fusion-pacing therapy; and

means for delivering one of an anti-tachycardia pacing (ATP) sequence and a defibrillation therapy via one of the epicardial patch-type assembly, the pericardial electrode, the helical screw-type electrode, and a high voltage defibrillation coil coupled to the non-transvenous cardiac therapy device.

19. An apparatus according to claim 18, wherein the arrhythmia comprises a ventricular arrhythmia.

20. A non-transvenous cardiac therapy apparatus for delivering single-ventricular fusion pacing therapy, comprising:

a) a P-wave detecting circuit coupled to a far-field subcutaneous electrode array (SEA) of a non-transvenous cardiac therapy apparatus;

b) an R-wave detecting circuit coupled to the SEA;

c) a timer adapted to measure the time elapsed between a detected P-wave and a detected R-wave (as a P-R interval);

d) means for decrementing the P-R interval by a predetermined amount as the fusion AV (FAV) interval; and

e) an electrode coupled to one of the epicardium and the pericardium of the left ventricle and adapted to deliver a single pacing stimulus to the left ventricle at the expiration of the FAV interval.

21. An apparatus according to claim 20, further comprising:

a high voltage defibrillation electrode spaced from one of the epicardium and the pericardium; and

a high voltage defibrillation circuit coupled to the high voltage defibrillation electrode and disposed within the non-transvenous cardiac therapy apparatus.