SYSTEMS AND METHODS FOR SELECTIVELY LIMITING MULTI-SITE VENTRICULAR PACING DELAYS DURING OPTIMIZATION OF CARDIAC RESYNCHRONIZATION THERAPY PARAMETERS

• US 20120185012A1
• Filed: 01/19/2011
• Published: 07/19/2012
• Est. Priority Date: 01/19/2011
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Ryu, Kyungmoo, Keel, Allen, Hellman, Heidi, Svensson, Tomas
• Granted Patent: US 8,583,230 B2
• Time in Patent Office: Days
• US Class Current: 607/25
• 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 1/3684 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
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold

Abstract

Techniques are provided for use with implantable cardiac stimulation devices equipped for multi-site left ventricular (MSLV) cardiac pacing. Briefly, intraventricular and interventricular conduction delays are detected for paced cardiac events. Maximum pacing time delays are determined for use with MSLV pacing where the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation, such as fusion or lack of capture. MSLV pacing delays are then set to values no greater than the maximum pacing delays and cardiac resynchronization therapy (CRT) is delivered using the MSLV pacing delays. In an example where an optimal interventricular pacing delay (VV) is determined in advance using intracardiac electrogram-based or hemodynamic-based optimization techniques, the optimal value for VV can be used as a limiting factor when determining the maximum MSLV pacing time delays.

Claims

1. A method for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead in combination with an RV lead, the method comprising:

detecting intraventricular and interventricular conduction delays for paced cardiac events;

determining maximum pacing time delays for use with MSLV pacing, wherein the maximum pacing time delays are set, based on the conduction delays, to values sufficient to avoid capture problems due to wavefront propagation;

setting MSLV pacing delays to values no greater than the maximum pacing delays; and

controlling the delivery of ventricular pacing to deliver a set of pulses using the MSLV pacing delays.

2. The method of claim 1 wherein the maximum MSLV pacing delays are set to values sufficient to avoid lack of capture and fusion caused by propagating wavefronts from other pacing sites.

3. The method of claim 1 wherein the device accommodates two programmable MSLV delays (IED#1 and IED#2).

4. The method of claim 3 wherein the device is programmable to a first MSLV pacing sequence (Seq#1) wherein an RV pulse is followed by an LV1 pacing pulse and then by an LV2 pacing pulse, wherein LV1 represents a first LV pacing site, LV2 represents a second LV pacing site, and a first pacing delay (IED#1) is applied between the RV and LV1 pulses and a second pacing delay (IED#2) is applied between the LV1 and LV2 pulses.

5. The method of claim 4 wherein the first delay (IED#1) is set no greater than a maximum programmable first delay (IED#1_max) set to the lesser of an initial IED#1_max value and a first paced interventricular conduction delay (RVLV1) measured within the patient.

6. The method of claim 5 wherein the second delay (IED#2) is set no greater than a maximum programmable second delay (IED#2_max) set to the lesser of an initial IED#2_max value and a paced intraventricular conduction delay (LVLV) measured within the patient.

7. The method of claim 6 wherein IED#1_max is set to Min(initial IED#1_max, RVLV1—

a fusion avoidance offset.)

8. The method of claim 7 wherein IED#2_max is set to Min(initial IED#2_max, LVLV—

the fusion avoidance offset.)

9. The method of claim 3 wherein the device is programmable to a second MSLV pacing sequence (Seq#2) wherein an LV1 pulse is followed by an LV2 pacing pulse and then by an RV pacing pulse, wherein a first pacing delay (IED#1) is applied between the LV1 and LV2 pulses and a second pacing delay (IED#2) is applied between the LV2 and RV pulses.

10. The method of claim 9 wherein the first delay (IED#1) is set no greater than a maximum programmable first delay (IED#1_max) set to the lesser of an initial IED#1_max value and a paced intraventricular conduction delay (LVLV) measured within the patient.

11. The method of claim 1 wherein the setting the MSLV pacing delays includes performing an optimization search to identify preferred values for the MSLV pacing delays within a range of values no greater than the maximum MSLV pacing delays.

12. The method of claim 1 wherein the setting the MSLV pacing delays includes inputting user-specified values for the MSLV pacing delays from within a range of values no greater than the maximum MSLV pacing delays.

13. The method of claim 1 wherein the implantable device is used in conjunction with an external system and wherein at least some of the steps are performed by the external system.

14. The method of claim 1 wherein the implantable device is used in conjunction with an external system and wherein at least some of the steps are performed by the device.

15. A system for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead in combination with an RV lead, the method comprising:

an intraventricular/interventricular activation time detector operative to detect intraventricular and interventricular conduction delays for paced cardiac events;

a maximum MSLV pacing time delay determination system operative to determine maximum pacing time delays for use with MSLV pacing, wherein the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation;

an MSLV pacing delay specification system operative to set MSLV pacing delays to values no greater than the maximum pacing delays; and

an MSLV controller operative to control delivery of ventricular pacing to deliver a set of pulses using the MSLV pacing delays.

16. A system for use with an implantable cardiac stimulation device equipped for multi-site left ventricular (MSLV) pacing using a multi-pole LV lead in combination with an RV lead, the method comprising:

means for detecting intraventricular and interventricular activation times for paced cardiac events;

means for determining maximum pacing time delays for use with MSLV pacing, wherein the maximum pacing time delays are set based on the conduction delays to values sufficient to avoid capture problems due to wavefront propagation;

means for setting MSLV pacing delays to values no greater than the maximum pacing delays; and

means for controlling delivery of ventricular pacing to deliver a set of pulses using the MSLV pacing delays.