Bi-chamber cardiac pacing system employing unipolar left heart chamber lead in combination with bipolar right chamber lead
First Claim
1. A method of sensing of spontaneous cardiac depolarizations in right and left heart chambers and delivering right or left heart chamber pacing pulse to the right or left heart chamber for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting depolarizations wherein said method comprises the steps of:
- advancing a unipolar pace/sense lead into a left heart chamber blood vessel to situate a left heart chamber active pace/sense electrode of the unipolar pace/sense lead adjacent to the left heart chamber;
advancing a bipolar pace/sense lead into the right heart chamber to locate a right heart chamber active pace/sense electrode and indifferent pace/sense electrode in relation to the right heart chamber;
sensing right heart chamber spontaneous cardiac depolarizations across the right heart chamber active and indifferent pace/sense electrodes and providing a right heart chamber sense event signal;
timing out a pacing interval from a right heart chamber sense event signal or a previously delivered pacing pulse; and
upon providing of a right heart chamber sense event signal or upon timing out said pacing escape interval, selectively generating and delivering one of a right heart chamber pacing pulse across said right heart chamber active and indifferent pace/sense electrodes and a left heart chamber pacing pulse along a trans-ventricular pacing path between said left heart chamber active pace/sense electrode and said right heart chamber indifferent pace/sense electrode.
1 Assignment
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Accused Products
Abstract
In a bi-ventricular pacing system, an implantable pulse generator optionally having an IPG indifferent electrode is coupled to a small diameter, unipolar, left ventricular (LV) lead and a bipolar right ventricular (RV) lead. The LV lead is advanced through the superior vena cava, the right atrium, the ostium of the coronary sinus (CS), the CS, and into a coronary vein descending from the CS to locate the LV active pace/sense electrode at a desired LV pace/sense site. An LV lead placed on an epicardial surface can substitute. The RV lead in a preferred embodiment is advanced into the RV chamber to locate RV active and indifferent pace/sense electrodes therein. Sensing of RV spontaneous cardiac depolarizations to provide a RV sense event signal and delivery of RV pacing pulses is conducted across the RV active pace/sense electrode and one of the RV or IPG indifferent pace/sense electrodes. Sensing of LV spontaneous cardiac depolarizations to provide a LV sense event signal is conducted across the LV active pace/sense electrode and one of the RV active or indifferent pace/sense electrodes or the IPG indifferent pace/sense electrodes. Delivery of LV pacing pulses is conducted across the LV active pace/sense electrode and the RV indifferent pace/sense electrode. A similar arrangement is disclosed for left atrial (LA) and right atrial (RA) pacing and sensing.
92 Citations
23 Claims
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1. A method of sensing of spontaneous cardiac depolarizations in right and left heart chambers and delivering right or left heart chamber pacing pulse to the right or left heart chamber for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting depolarizations wherein said method comprises the steps of:
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advancing a unipolar pace/sense lead into a left heart chamber blood vessel to situate a left heart chamber active pace/sense electrode of the unipolar pace/sense lead adjacent to the left heart chamber;
advancing a bipolar pace/sense lead into the right heart chamber to locate a right heart chamber active pace/sense electrode and indifferent pace/sense electrode in relation to the right heart chamber;
sensing right heart chamber spontaneous cardiac depolarizations across the right heart chamber active and indifferent pace/sense electrodes and providing a right heart chamber sense event signal;
timing out a pacing interval from a right heart chamber sense event signal or a previously delivered pacing pulse; and
upon providing of a right heart chamber sense event signal or upon timing out said pacing escape interval, selectively generating and delivering one of a right heart chamber pacing pulse across said right heart chamber active and indifferent pace/sense electrodes and a left heart chamber pacing pulse along a trans-ventricular pacing path between said left heart chamber active pace/sense electrode and said right heart chamber indifferent pace/sense electrode. - View Dependent Claims (2, 3, 4, 5, 6, 7)
sensing spontaneous cardiac depolarizations across the right heart chamber and left heart chamber active pace/sense electrodes and providing a left heart chamber sense event signal; and
the timing step further comprises the step of;
timing out said pacing interval from a right or left heart chamber sense event signal; and
upon a left heart chamber sense event signal, selectively delivering one of a right heart chamber pacing pulse across said right heart chamber active and indifferent pace/sense electrodes and a left heart chamber pacing pulse across said left heart chamber active pace/sense electrode and said right heart chamber indifferent pace/sense electrodes.
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3. The method of claim 2, further comprising the steps of:
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timing out a triggered pacing delay from the providing of a right heart chamber sense event signal or a left heart chamber sense event signal or the timing out of the pacing interval; and
at the time-out of the triggered pacing delay;
selectively generating and delivering the left heart chamber pacing pulse across said left heart chamber active pace/sense electrode and said right heart chamber indifferent pace/sense electrodes when said right heart chamber pacing pulse is delivered across said right heart chamber active and indifferent pace/sense electrodes at the start of the triggered pacing delay; and
selectively generating and delivering the right heart chamber pacing pulse across said right heart chamber active pace/sense and indifferent electrodes when said left heart chamber pacing pulse is delivered across said left heart chamber active pace/sense electrode and said indifferent right heart chamber pace/sense electrode at the start of the triggered pacing delay.
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4. The method of claim 3, wherein the right heart chamber comprises the right atrium and the left heart chamber comprises the left atrium.
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5. The method of claim 3, wherein the right heart chamber comprises the right ventricle and the left heart chamber comprises the left ventricle.
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6. The method of claim 1, wherein the right heart chamber comprises the right atrium and the left heart chamber comprises the left atrium.
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7. The method of claim 1, wherein the right heart chamber comprises the right ventricle and the left heart chamber comprises the left ventricle.
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8. In an implantable medical device having a pacemaker for sensing spontaneous cardiac depolarizations in right and left heart chambers and delivering right or left heart chamber pacing pulse to the right or left heart chamber for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting depolarizations, apparatus comprising:
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a unipolar pace/sense lead adapted to situate a left heart chamber active pace/sense electrode of the unipolar pace/sense lead adjacent to the left heart chamber;
a bipolar pace/sense lead adapted to situate a right heart chamber active pace/sense electrode and indifferent pace/sense electrode in relation to the right heart chamber; and
a pacing pulse generator comprising;
right heart chamber sensing means for sensing right heart chamber spontaneous cardiac depolarizations across the right heart chamber active and indifferent pace/sense electrodes and providing a right heart chamber sense event signal;
escape interval timing means for timing out a pacing escape interval establishing a pacing rate from a right heart chamber sense event signal;
pacing pulse generating means operable upon providing of a right heart chamber sense event signal or upon timing out said pacing escape interval for selectively generating and delivering one of a right heart chamber pacing pulse across said right heart chamber active and indifferent pace/sense electrodes and a left heart chamber pacing pulse along a trans-ventricular pacing path between said left heart chamber active pace/sense electrode and said right heart chamber indifferent pace/sense electrodes. - View Dependent Claims (9, 10, 11, 12, 13, 14)
left heart chamber sensing means for sensing spontaneous cardiac depolarizations across the right heart chamber and left heart chamber active pace/sense electrodes and providing a left heart chamber sense event signal; and
wherein;
said escape interval timing means further comprises means for timing out said pacing interval from a right or left heart chamber sense event signal; and
said pacing pulse generating means is operable upon provision of a left heart chamber sense event signal for selectively delivering one of a right heart chamber pacing pulse across said right heart chamber active and indifferent pace/sense electrodes and a left heart chamber pacing pulse across said left heart chamber active pace/sense electrode and said right heart chamber indifferent pace/sense electrodes.
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10. The pacemaker of claim 9, wherein said pulse generating means further comprises
triggered pacing delay timing means for timing out a triggered pacing delay from the providing of a right heart chamber sense event signal or a left heart chamber sense event signal or the timing out of the pacing interval; - and wherein;
said pulse generating means is operable at the time out of the triggered pacing delay to selectively generate and deliver the left heart chamber pacing pulse across said left heart chamber active pace/sense electrode and said right heart chamber indifferent pace/sense electrodes when said right heart chamber pacing pulse is delivered across said right heart chamber active and indifferent pace/sense electrodes at the start of the triggered pacing delay and to selectively generate and deliver the right heart chamber pacing pulse across said right heart chamber active pace/sense and indifferent electrodes when said left heart chamber pacing pulse is delivered across said left heart chamber active pace/sense electrode and said indifferent right heart chamber pace/sense electrode at the start of the triggered pacing delay.
- and wherein;
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11. The pacemaker of claim 10, wherein the right heart chamber comprises the right atrium and the left heart chamber comprises the left atrium.
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12. The pacemaker of claim 10, wherein the right heart chamber comprises the right ventricle and the left heart chamber comprises the left ventricle.
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13. The pacemaker of claim 8, wherein the right heart chamber comprises the right atrium and the left heart chamber comprises the left atrium.
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14. The pacemaker of claim 8, wherein the right heart chamber comprises the right ventricle and the left heart chamber comprises the left ventricle.
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15. A method of sensing of spontaneous cardiac depolarizations in right and left ventricles and delivering right or left ventricular pacing pulse to the right or left ventricle for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations through the right and left ventricles that compromise cardiac output, wherein said method comprises the steps of:
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advancing a unipolar pace/sense lead having only a left ventricular active pace/sense electrode through the coronary sinus of the heart and into a left ventricular blood vessel branching therefrom to situate the left ventricular active pace/sense electrode of the unipolar pace/sense lead adjacent to the left ventricle;
advancing a bipolar pace/sense lead into the right ventricle to locate a right ventricular active pace/sense electrode in the right ventricular apex and an indifferent pace/sense electrode within the right ventricular chamber;
sensing right ventricular spontaneous cardiac depolarizations across the right ventricular active and indifferent pace/sense electrodes and providing a right ventricular sense event signal;
timing out a pacing escape interval from a right ventricular sense event signal;
selectively generating and delivering a right ventricular pacing pulse across said right ventricular active and indifferent pace/sense electrodes at the time-out of said pacing escape interval; and
selectively generating and delivering a left ventricular pacing pulse along a transventricular pacing path between said left ventricular active pace/sense electrode and said right ventricular indifferent pace/sense electrodes at the time-out of said pacing escape interval. - View Dependent Claims (16)
sensing spontaneous cardiac depolarizations across the right ventricular and left ventricular active pace/sense electrodes and providing a left ventricular sense event signal; and
the timing step further comprises the step of;
timing out a pacing escape interval establishing a pacing rate from a right or left ventricular sense event signal.
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17. A pacemaker for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in one of the right or left heart chamber to the other of the left or right heart chamber comprising:
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right heart lead means for locating active and indifferent right heart chamber pace/sense electrodes in relation with the right heart chamber;
left heart lead means for locating an active left heart chamber pace/sense electrode in relation with the left heart chamber; and
an implantable pulse generator coupled to said right and left heart lead means and comprising;
right heart chamber depolarization sensing means coupled with said right heart chamber lead means for sensing spontaneous cardiac depolarizations originating in the right heart chamber and conducted cardiac depolarizations originating in the left heart chamber due to a spontaneous cardiac depolarization or delivery of a left heart pacing pulse to the left heart chamber and for providing a right heart chamber sense event signal in response to either a sensed spontaneous or conducted cardiac depolarization;
left heart chamber depolarization sensing means coupled with said active left heart chamber pace/sense electrode and one of said active or indifferent right heart chamber pace/sense electrodes for sensing spontaneous cardiac depolarizations originating in the left heart chamber and conducted cardiac depolarizations originating in the right heart chamber due to a spontaneous cardiac depolarization or delivery of a right heart pacing pulse to the right heart chamber and for providing a left heart chamber sense event signal in response to either a sensed spontaneous or conducted cardiac depolarization;
right heart pacing pulse output means coupled with said right heart chamber lead means and selectively responsive to an applied right heart chamber pace trigger signal for generating and delivering a right heart pacing pulse across said active and indifferent right heart chamber pace/sense electrodes to evoke a right heart chamber depolarization;
left heart pacing pulse output means coupled with said right and left heart chamber lead means and selectively responsive to an applied left heart chamber pace trigger signal for generating and delivering a left heart pacing pulse along a crossventricular pacing path between said active left heart chamber pace/sense electrode and said indifferent right heart chamber pace/sense electrode to evoke a left heart chamber depolarization; and
escape interval timing means for timing an escape interval establishing a pacing rate and providing one or both of the right and left heart chamber pace trigger signals at the time-out of the escape interval, the escape interval timing means further comprising reset means for restarting the timing of the escape interval upon provision of a pace trigger signal and upon provision of one of the right or left heart chamber sense event signals that is not refractory.
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18. A pacemaker for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in one of the right or left heart chamber to the other of the left or right heart chamber comprising:
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right heart lead means for locating active and indifferent right heart chamber pace/sense electrodes in relation with the right heart chamber;
left heart lead means for locating an active left heart chamber pace/sense electrode in relation with the left heart chamber;
an implantable pulse generator having a housing bearing an indifferent housing pace/sense electrode, said implantable pulse generator further comprising;
right heart chamber depolarization sensing means coupled with said active right heart chamber pace/sense electrode and one of said indifferent right heart electrode or housing pace/sense electrodes for sensing spontaneous cardiac depolarizations originating in the right heart chamber and conducted cardiac depolarizations originating in the left heart chamber due to a spontaneous cardiac depolarization or delivery of a left heart pacing pulse to the left heart chamber and for providing a right heart chamber sense event signal in response to either a sensed spontaneous or conducted cardiac depolarization;
left heart chamber depolarization sensing means coupled with said active left heart chamber pace/sense electrode and one of said active or indifferent right heart or indifferent housing pace/sense electrodes for sensing spontaneous cardiac depolarizations originating in the left heart chamber and conducted cardiac depolarizations originating in the right heart chamber due to a spontaneous cardiac depolarization or delivery of a right heart pacing pulse to the right heart chamber and for providing a left heart chamber sense event signal in response to either a sensed spontaneous or conducted cardiac depolarization;
right heart pacing pulse output means coupled with said right heart chamber lead means and selectively responsive to an applied right heart chamber pace trigger signal for generating and delivering a right heart pacing pulse across said active right heart pace/sense electrode and one of said indifferent right heart or housing pace/sense electrodes to evoke a right heart chamber depolarization;
left heart pacing pulse output means coupled with said right and left heart chamber lead means and selectively responsive to an applied left heart chamber pace trigger signal for generating and delivering a left heart pacing pulse along a transventricular pacing path between said active left heart chamber pace/sense electrode and said indifferent right heart chamber pace/sense electrode to evoke a left heart chamber depolarization; and
escape interval timing means for timing an escape interval establishing a pacing rate and providing one or both of the right and left heart chamber pace trigger signals at the time-out of the escape interval, the escape interval timing means further comprising reset means for restarting the timing of the escape interval upon provision of a pace trigger signal and upon provision of one of the right or left heart chamber sense event signals that is not refractory.
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19. A pacemaker for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in one of the right or left heart chamber to the other of the left or right heart chamber comprising:
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right heart lead means for locating active and indifferent right heart chamber pace/sense electrodes in relation with the right heart chamber;
left heart lead means for locating an active left heart chamber pace/sense electrode in relation with the left heart chamber;
an implantable pulse generator having a housing bearing an indifferent housing pace/sense electrode, said implantable pulse generator further comprising;
right heart chamber depolarization sensing means coupled with said active right heart chamber pace/sense electrode and one of said indifferent right heart electrode or housing pace/sense electrodes for sensing spontaneous cardiac depolarizations originating in the right heart chamber and conducted cardiac depolarizations originating in the left heart chamber due to a spontaneous cardiac depolarization or delivery of a left heart pacing pulse to the left heart chamber and for providing a right heart chamber sense event signal in response to either a sensed spontaneous or conducted cardiac depolarization;
left heart chamber depolarization sensing means coupled with said active left heart chamber pace/sense electrode and one of said active or indifferent right heart chamber pace/sense electrodes for sensing spontaneous cardiac depolarizations originating in the left heart chamber and conducted cardiac depolarizations originating in the right heart chamber due to a spontaneous cardiac depolarization or delivery of a right heart pacing pulse to the right heart chamber and for providing a left heart chamber sense event signal in response to either a sensed spontaneous or conducted cardiac depolarization;
right heart pacing pulse output means coupled with said right heart chamber lead means and selectively responsive to an applied right heart chamber pace trigger signal for generating and delivering a right heart pacing pulse across said active right heart chamber pace/sense electrode and one of said indifferent right heart or housing pace/sense electrodes to evoke a right heart chamber depolarization;
left heart pacing pulse output means coupled with said right and left heart chamber lead means and selectively responsive to an applied left heart chamber pace trigger signal for generating and delivering a left heart pacing pulse along a transventricular pacing path between said active left heart chamber and said indifferent right heart chamber pace/sense electrodes to evoke a left heart chamber depolarization; and
escape interval timing means for timing an escape interval establishing a pacing rate and providing one or both of the right and left heart chamber pace trigger signals at the time-out of the escape interval, the escape interval timing means further comprising reset means for restarting the timing of the escape interval upon provision of a pace trigger signal and upon provision of one of the right or left heart chamber sense event signals that is not refractory.
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20. In a multi-site cardiac pacemaker, a method of selectively sensing spontaneous cardiac depolarizations in the right and left ventricles and delivering pacing pulses to the right and left heart ventricles for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations through the right and left heart chambers that compromise cardiac output, wherein said method comprises the steps of:
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sensing spontaneous atrial depolarizations and providing atrial sense event signals;
timing out an AV delay from the atrial sense event signals that are characterized as non-refractory;
sensing spontaneous cardiac depolarizations in the right ventricle and providing right ventricular sense event signals;
sensing spontaneous cardiac depolarizations in the left ventricle and providing left ventricular sense event signals;
timing out a V-A escape interval establishing a pacing rate from a selected one of the right and left ventricular sense event signals occurring during the AV delay or the V-A escape interval that is characterized as non-refractory; and
at the time-out of the AV delay, delivering a first pacing pulse either as a right ventricular pacing pulse across said active and indifferent right heart chamber pace/sense electrodes to the right ventricle to evoke a right ventricular depolarization or as a left ventricular pacing pulse along a trans-ventricular pacing path between said active left heart chamber pace/sense electrode and said indifferent right heart chamber pace/sense electrode to the left ventricle to evoke a left ventricular depolarization.
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21. In a multi-site cardiac pacemaker, a system for selectively sensing spontaneous cardiac depolarizations in the right and left ventricles and delivering pacing pulses to the right and left heart ventricles for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations through the right and left heart chambers that compromise cardiac output, wherein said pacemaker further comprises:
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a unipolar left ventricular lead adapted to be advanced into a left ventricular blood vessel to situate a left ventricular active pace/sense electrode of the unipolar pace/sense lead adjacent to the left ventricle;
a bipolar right ventricular lead adapted to be advanced into the right ventricle to locate a right ventricular active pace/sense electrode and indifferent pace/sense electrode in relation to the right ventricle;
an atrial lead adapted to be advanced to the atria to locate atrial pace/sense electrodes in relation to the atria; and
a pulse generator comprising;
an atrial sense amplifier coupled to the atrial lead for sensing spontaneous atrial depolarizations and providing atrial sense event signals;
an AV delay timer for timing out an AV delay from the atrial sense event signals that are characterized as non-refractory;
a right ventricular sense amplifier coupled to the right ventricular lead for sensing spontaneous cardiac depolarizations in the right ventricle and providing right ventricular sense event signals;
a left ventricular sense amplifier coupled to the right and left ventricular leads for sensing spontaneous cardiac depolarizations in the left ventricle and providing left ventricular sense event signals;
an escape interval timer for timing out a V-A escape interval establishing a pacing rate from a selected one of the right and left ventricular sense event signals occurring during the AV delay or the V-A escape interval that is characterized as non-refractory;
ventricular pacing pulse generating means operable at the time-out of the AV delay for delivering a first pacing pulse either as a right ventricular pacing pulse across the active right ventricular pace/sense electrode and a selected indifferent pacing electrode to evoke a right ventricular depolarization or as a left ventricular pacing pulse along a trans-ventricular pacing path between said active left ventricular pace/sense electrode and said indifferent right ventricular pace/sense electrode to the left ventricle to evoke a left ventricular depolarization; and
means responsive to delivery of the first pacing pulse for restarting the timing out of the V-A escape interval. - View Dependent Claims (22, 23)
said escape interval timing means further comprises means for timing out said pacing interval from a right or left ventricular sense event signal; and
said pacing pulse generating means is operable upon provision of a left ventricular sense event signal for selectively delivering one of a right ventricular pacing pulse across said right ventricular active and indifferent pace/sense electrodes and a left ventricular pacing pulse across said left ventricular active pace/sense electrode and said right ventricular indifferent pace/sense electrodes.
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23. The pacemaker of claim 22, wherein said pulse generating means further comprises
triggered pacing delay timing means for timing out a triggered pacing delay from the providing of a right ventricular sense event signal or a left ventricular sense event signal or the timing out of the pacing interval; - and wherein;
said pulse generating means is operable at the time out of the triggered pacing delay to selectively generate and deliver the left ventricular pacing pulse across said left ventricular active pace/sense electrode and said right ventricular indifferent pace/sense electrodes when said right ventricular pacing pulse is delivered across said right ventricular active and indifferent pace/sense electrodes at the start of the triggered pacing delay and to selectively generate and deliver the right ventricular pacing pulse across said right ventricular active pace/sense and indifferent electrodes when said left ventricular pacing pulse is delivered across said left ventricular active pace/sense electrode and said indifferent right ventricular pace/sense electrode at the start of the triggered pacing delay.
- and wherein;
Specification