SYSTEMS AND METHODS FOR ASSESSING AND EXPLOITING CONCURRENT CATHODAL AND ANODAL CAPTURE USING AN IMPLANTABLE MEDICAL DEVICE
First Claim
1. A method for use with an implantable medical device equipped for bipolar electrical stimulation and sensing of heart tissues using cardiac electrodes, the method comprising:
- delivering bipolar stimulus using a pair of the cardiac electrodes while sensing bipolar intracardiac electrogram (IEGM) signals using the pair of the cardiac electrodes;
detecting an indication within the bipolar IEGM signals of evoked responses (ERs) representative of anodal capture within myocardial tissues associated with an anode of the pair of the cardiac electrodes and cathodal capture within myocardial tissues associated with a cathode of the pair of the cardiac electrodes; and
determining an anodal/cathodal capture threshold sufficient to achieve both anodal and cathodal capture from the indication within the bipolar IEGM signals of the ERs.
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Abstract
Techniques are provided for use by an implantable medical device for assessing and controlling concurrent anodal/cathodal capture. In one example, the device delivers bipolar pacing stimulus while sensing a bipolar intracardiac electrogram (IEGM) and while adjusting a magnitude of the pacing stimulus. The device analyzes the bipolar IEGM signals to detect an indication of activation representative of concurrent anodal and cathodal capture. Preferably, the pulse magnitude is set relative to the anodal/cathodal capture threshold based upon clinician programming in response to the needs of the patient. In this manner, concurrent anodal and cathodal capture can be selectively activated or deactivated based on clinician instructions received from a device programmer or other external programming device. Techniques exploiting both bipolar and unipolar IEGM signals to assess and control concurrent anodal/cathodal capture are also described. Techniques for use with quad-pole leads to achieve dual-site or quad-site capture are also set forth.
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Citations
25 Claims
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1. A method for use with an implantable medical device equipped for bipolar electrical stimulation and sensing of heart tissues using cardiac electrodes, the method comprising:
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delivering bipolar stimulus using a pair of the cardiac electrodes while sensing bipolar intracardiac electrogram (IEGM) signals using the pair of the cardiac electrodes; detecting an indication within the bipolar IEGM signals of evoked responses (ERs) representative of anodal capture within myocardial tissues associated with an anode of the pair of the cardiac electrodes and cathodal capture within myocardial tissues associated with a cathode of the pair of the cardiac electrodes; and determining an anodal/cathodal capture threshold sufficient to achieve both anodal and cathodal capture from the indication within the bipolar IEGM signals of the ERs. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22)
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23. A system for use with an implantable medical device equipped for bipolar electrical stimulation and sensing of heart tissues using cardiac electrodes, the system comprising:
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a bipolar stimulus controller operative to control delivery of bipolar stimulus using a pair of cardiac electrodes while sensing bipolar intracardiac electrogram (IEGM) signals using the pair of cardiac electrodes; an evoked response (ER) detection system operative to detect an indication within the bipolar IEGM signals of ERs representative of anodal capture within myocardial tissues associated with an anode of the pair of cardiac electrodes and cathodal capture within myocardial tissues associated with a cathode of the electrode pair of cardiac electrodes; and an anodal/cathodal capture threshold determination system operative to determine the anodal/cathodal capture threshold sufficient to achieve both anodal and cathodal capture from the indication within the bipolar IEGM signals of the ERs. - View Dependent Claims (24)
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25. A system for use with an implantable medical device equipped for bipolar electrical stimulation and sensing of heart tissues using cardiac electrodes, the system comprising:
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means for delivering bipolar stimulus using a pair of the cardiac electrodes while sensing bipolar intracardiac electrogram (IEGM) signals using the pair of the cardiac electrodes; means for detecting an indication within the bipolar IEGM signals of evoked responses (ERs) representative of anodal capture within myocardial tissues associated with an anode of the pair of the cardiac electrodes and cathodal capture within myocardial tissues associated with a cathode of the pair of the cardiac electrodes; and means for determining an anodal/cathodal capture threshold sufficient to achieve both anodal and cathodal capture from the indication within the bipolar IEGM signals of the ERs.
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Specification