SYSTEMS AND METHODS FOR DETERMINING INTER-ATRIAL CONDUCTION DELAYS USING MULTI-POLE LEFT VENTRICULAR PACING/SENSING LEADS

• US 20090299423A1
• Filed: 06/03/2008
• Published: 12/03/2009
• Est. Priority Date: 06/03/2008
• Status: Abandoned Application

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Min, Xiaoyi
• Application Number:
  US12/132,563
• Publication Number:
  US 20090299423A1
• Time in Patent Office: Days
• US Class Current: 607/9
• 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 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

Techniques are provided for use by a pacemaker or other implantable medical device for estimating optimal atrio-ventricular pacing delays within a patient. The inter-atrial conduction delays (IACDs) are determined based, at least in part, on atrial far-field (AFF) signals sensed using a multi-pole left ventricular (LV) lead, such as an LV lead implanted via the coronary sinus (CS) with a plurality of electrodes. In one example, for intrinsic atrial events, the IACD is equal to the interval from the beginning of a P-wave detected via a right atrial lead and the end (or peak) of an AFF event detected via a left atrial ring electrode of a CS/LV lead. For paced atrial events, the IACD is instead equal to the interval from the A-pulse to the end (or peak) of the AFF event detected via the CS/LV lead. AV/PV pacing delays are then calculated based on the IACD adjusted by an offset.

Claims

1. A method for delivering cardiac pacing therapy to the heart of a patient in which an implantable cardiac stimulation device is implanted having a left ventricular (LV) lead, the method comprising:

determining inter-atrial (A-A) conduction delays based on atrial far-field signals sensed using the LV lead;

determining atrio-ventricular (AV/PV) pacing delays based on the inter-atrial (A-A) delays; and

delivering pacing therapy using the atrio-ventricular (AV/PV) pacing delays.

2. The method of claim 1 wherein the LV lead is a multi-pole lead having at least one electrode for positioning near the left atrium (LA) and wherein determining inter-atrial (A-A) conduction delays is performed using unipolar atrial far-field signals sensed using a selected pole near the LA.

3. The method of claim 2 wherein the multi-pole LV lead is a coronary sinus (CS) lead having an electrode for positioning in the CS near the LA and wherein determining inter-atrial (A-A) conduction delays is performed using unipolar atrial far-field signals sensed using the electrode positioned in the CS near the LA.

4. The method of claim 1 wherein the implantable medical device also includes a right atrial (RA) lead and wherein inter-atrial (A-A) conduction delays are determined based on the atrial far-field signals sensed using the LV lead along with atrial signals sensed by the RA lead.

5. The method of claim 1 wherein the implantable medical device wherein inter-atrial (A-A) conduction delays are determined based on the atrial far-field signals sensed using the LV lead along with atrial signals sensed by one or more electrodes implanted adjacent the atria.

6. The method of claim 4 wherein determining inter-atrial (A-A) conduction delays includes:

identifying a beginning of atrial activation sensed using the near-field signals sensed by the RA lead;

identifying a selected portion of the atrial activation sensed using the far-field signals sensed by the LV lead; and

calculating the inter-atrial (A-A) conduction delays based on the interval between the beginning of the atrial activation sensed using the near-field signals sensed by the RA lead and the selected portion of the atrial activation sensed using the far-field signals sensed by the LV lead.

7. The method of claim 6 wherein the selected portion of the atrial activation sensed using the far-field signals sensed by the LV lead is the peak of the activation sensed using the far-field signals sensed by the LV lead.

8. The method of claim 6 wherein the selected portion of the atrial activation sensed using the far-field signals sensed by the LV lead is the end of the activation sensed using the far-field signals sensed by the LV lead.

9. The method of claim 6 wherein identifying the beginning of atrial activation using the near-field signals sensed by the RA lead includes detecting a near-field P-wave within the near-field signals and identifying the beginning of atrial activation as corresponding to the beginning of the near-field P-wave.

10. The method of claim 8 wherein sensing atrial activation within the far-field signals sensed by the LV lead includes:

opening a detection window within an LV sensing channel at a time triggered by the near-field signals sensed by the RA lead; and

detecting cardiac signals within the detection window of the LV sensing channel and identifying the cardiac signals as corresponding to far-field atrial activation.

11. The method of claim 10 wherein sensing atrial activation within the far-field signals sensed by the LV lead further includes:

detecting near-field ventricular signals using a ventricular lead representative of a QRS complex; and

closing the detection window within the LV sensing channel upon detection of the earlier of an LV QRS complex and an RV QRS complex within the near-field ventricular signals.

12. The method of claim 11 wherein the implantable medical device also includes a right ventricular (RV) lead and wherein sensing atrial activation within the far-field signals sensed by the LV lead further includes:

detecting near-field ventricular signals using the RV lead; and

closing the detection window within the LV sensing channel at a time triggered by detection of the near-field signals sensed by the RV lead.

13. The method of claim 11 wherein sensing atrial activation within the far-field signals sensed by the LV lead further includes:

detecting near-field ventricular signals using the LV lead; and

closing the detection window within the LV sensing channel at a time triggered by detection of the near-field ventricular signals sensed by the LV lead.

14. The method of claim 13 wherein detecting the near-field ventricular signals using the LV lead is performed using a bipolar LV sensing channel whereas detecting far-field atrial signals using the LV lead is performed using a unipolar LV sensing channel.

15. The method of claim 6 wherein determining atrio-ventricular (AV/PV) pacing delays based on the measured inter-atrial (A-A) delays includes setting the atrio-ventricular pacing delay values based on the selected portion of the atrial activation determined using the far-field atrial signals sensed by the LV lead.

16. A system for determining atrio-ventricular pacing delay values for use in delivering cardiac pacing therapy to the heart of a patient in which an implantable cardiac stimulation device is implanted having a left ventricular (LV) lead, the system comprising:

an inter-atrial conduction delay measuring unit operative to determine inter-atrial (A-A) conduction delays within the patient based on atrial far-field signals sensed using the LV lead; and

an atrio-ventricular (AV/PV) pacing delay determination unit operative to determine atrio-ventricular (AV/PV) pacing delays based on the measured inter-atrial (A-A) conduction delays.

17. A system for determining atrio-ventricular pacing delay values for use in delivering cardiac pacing therapy to the heart of a patient in which an implantable cardiac stimulation device is implanted having a left ventricular (LV) lead, the system comprising:

means for measuring inter-atrial (A-A) conduction delays based on atrial far-field signals sensed using the LV lead;

means for determining atrio-ventricular (AV/PV) pacing delays based on the measured inter-atrial (A-A) delays; and

means for delivering pacing therapy using the atrio-ventricular (AV/PV) pacing delays.