SYSTEMS AND METHODS FOR OPTIMIZING VENTRICULAR PACING DELAYS FOR USE WITH MULTI-POLE LEADS

• US 20110022110A1
• Filed: 07/22/2009
• Published: 01/27/2011
• Est. Priority Date: 07/22/2009
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Min, Xiaoyi
• Granted Patent: US 8,265,755 B2
• Time in Patent Office: Days
• US Class Current: 607/25
• 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 1/3684 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 implantable medical devices for controlling ventricular pacing using a multi-pole left ventricular (LV) lead. In one example, a single “V sense” test is performed to determine intrinsic interventricular conduction time delays (Δ_n) between the RV electrode and each of the LV electrodes of the multi-pole lead. Likewise, a single “RV pace” test is performed to determine paced interventricular conduction time delays (IVCD_RLn) between the RV electrode and each of the LV electrodes. A set of “LV pace” tests is then performed to determine paced interventricular conduction time delays (IVCD_LRn) between individual LV electrodes and the RV electrode. Optimal or preferred interventricular pacing delays are determined using the intrinsic interventricular conduction delay (Δ_n) values and a set of interventricular correction terms (ε_n) determined from the results of the RV pace test and the set of LV pace tests. With these techniques, overall test time can be reduced.

Claims

1. A method for controlling ventricular pacing for use by an implantable cardiac rhythm management device equipped with a multi-pole ventricular lead having a plurality of electrodes, the method comprising:

identifying an electrical event sufficient to trigger ventricular depolarization within the heart of a patient in which the device is implanted;

detecting a resulting ventricular depolarization at each of a plurality of electrodes of the multi-pole lead, the depolarization being detected at generally different times at each different electrode;

determining an interventricular conduction time delay for each of the plurality of electrodes of the multi-pole lead based on the depolarization triggered by the electrical event, the conduction time delay including at least one of a paced interventricular conduction time delay and an intrinsic interventricular conduction time delay; and

controlling ventricular pacing using a selected electrode of the multi-pole lead based, at least in part, on the interventricular conduction time delay determined for that electrode.

2. The method of claim 1 wherein the multi-pole lead is a left ventricular (LV) lead having a plurality of electrodes (LVn) and the device is equipped with a right ventricular (RV) lead and wherein the method is performed to control ventricular pacing delivered between an RV electrode of the RV lead and a selected electrode (LVn) of the multi-pole LV lead.

3. The method of claim 2 wherein detecting the resulting ventricular depolarization at each of a plurality of electrodes of the multi-pole lead includes detecting a resulting LV QRS complex (LVn QRS) at each of the plurality of LV electrodes (LVn) of the LV lead.

4. The method of claim 3 further including detecting a resulting RV QRS complex at the RV electrode of the RV lead and wherein the interventricular conduction time delay to be determined for each of the plurality of electrodes of the lead includes an intrinsic interventricular conduction time delay (Δ

_n) for each of the plurality of electrodes of the LV lead (LVn) based on the RV QRS and the LVn QRS complexes.

5. The method of claim 4 wherein controlling ventricular pacing includes setting an interventricular pacing delay (VV_n) for use with a selected electrode (LVn) of the LV lead based on:

VV_n=α

_n (Δ

_n+δ

_n), where α

_n is a coefficient and wherein ε

_n is an interventricular correction term for use with the selected electrode (LVn) of the LV lead.

6. The method of claim 4 wherein the electrical event sufficient to trigger ventricular depolarization is an intrinsic atrial depolarization (P-wave).

7. The method of claim 6 wherein the method further includes:

measuring an intrinsic atrioventricular time delay (PR_RV) between the P-wave and the RV QRS.

8. The method of claim 6 further including:

determining an intrinsic atrioventricular time delay (PR_LVn) between the P-wave and each of the plurality of LV electrodes.

9. The method of claim 8 further wherein determining PR_LVn for each of the plurality of LV electrodes is performed based on the PR_RV time delay and the respective Δ

_n delays.

10. The method of claim 4 wherein the electrical event sufficient to trigger ventricular depolarization is an atrial pacing pulse (A-pulse).

11. The method of claim 10 wherein the method further includes:

measuring an atrioventricular time delay (AR_RV) between the initial A-pulse and the RV QRS.

12. The method of claim 10 further including:

determining a paced atrioventricular time delay (AR_LVn) between the initial A-pulse and each of the plurality of LV electrodes.

13. The method of claim 12 wherein determining paced atrioventricular conduction time delays (AR_LVn) for each of the plurality of LV electrodes is performed based on the AR_RV time delay and the respective Δ

_n delays.

14. The method of claim 4 wherein the method is part of a V sense test for use in optimizing ventricular pacing delays.

15. The method of claim 3 wherein the electrical event sufficient to trigger ventricular depolarization is a pacing pulse (V_R-pulse) delivered to the RV via the RV lead and wherein the interventricular conduction time delay to be determined is a paced interventricular conduction time delay (IVCD).

16. The method of claim 15 wherein determining the paced interventricular conduction time delay (IVCD) includes determining a paced interventricular conduction delay (IVCD_RLn) from the RV electrode to each of the plurality of LVn electrodes of the LV lead based on the V_R pulse and the LVn QRS complexes.

17. The method of claim 1 wherein all of the steps are performed by the implantable medical device.

18. The method of claim 1 wherein at least some of the steps are performed by an external device based on signals received from the implantable medical device.

19. A system for controlling ventricular pacing for use by an implantable cardiac rhythm management device equipped with a multi-pole ventricular lead having a plurality of electrodes, the system comprising:

an electrical event identification unit operative to identify an electrical event sufficient to trigger ventricular depolarization within the heart of a patient in which the device is implanted;

a multi-pole ventricular depolarization detection unit operative to detect a resulting ventricular depolarization at each of a plurality of electrodes of the multi-pole lead, the depolarization being detected at generally different times at each different electrode;

a multi-pole interventricular conduction time delay determination unit operative to determine an interventricular conduction time delay for each of the plurality of electrodes of the multi-pole lead based on the depolarization triggered by the electrical event, the conduction time delay including at least one of a paced interventricular conduction time delay and an intrinsic interventricular conduction time delay; and

a multi-pole ventricular pacing controller operative to control ventricular pacing using a selected electrode of the multi-pole lead based, at least in part, on the interventricular conduction time delay determined for that electrode.

20. A system for controlling ventricular pacing for use by an implantable cardiac rhythm management device equipped with a multi-pole ventricular lead having a plurality of electrodes, the system comprising:

means for identifying an electrical event sufficient to trigger ventricular depolarization within the heart of a patient in which the device is implanted;

means for detecting a resulting ventricular depolarization at each of a plurality of electrodes of the multi-pole lead, the depolarization being detected at generally different times at each different electrode; and

means for determining an interventricular conduction time delay for each of the plurality of electrodes of the multi-pole lead based on the depolarization triggered by the electrical event, the conduction time delay including at least one of a paced interventricular conduction time delay and an intrinsic interventricular conduction time delay.