Method and apparatus for capture verification and threshold determination
First Claim
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1. A system for determining capture thresholds for a multi-site cardiac pacemaker, comprising:
- a pacemaker having;
(a) first and second pacing channels with each such channel comprising an electrode for disposing new a chamber of the heart, a pulse generator for outputting pacing pulses, and a channel interface for adjusting the pacing pulse energy, (b) a controller for controlling the operation of the pulse generators in accordance with a programmed pacing mode such that first and second pacing pulses are delivered from the first and second pacing channels, respectively, to one or both of the paired atria or to one or both of the paired ventricles during a cardiac cycle, and (c) a telemetry interface for communicating with an external programmer;
an external programmer having a controller for processing data received from the pacemaker, wherein the controller is programmed to;
generate a dual-channel capture template by recording a depolarization waveform produced when first and second pacing pulses are delivered from the first and second pacing channels at an energy sufficient to achieve capture by each of the first and second pacing pulses,generate a first channel capture template by recording a depolarization waveform produced when first pacing pulses are delivered from the first pacing channel at an energy sufficient to achieve capture by the first pacing pulses with no pacing pulses delivered by the second pacing channel,generate a second channel capture template by recording a depolarization waveform produced when second pacing pulses are delivered from the second pacing channel at an energy sufficient to achieve capture by the second pacing pulses with no pacing pulses delivered by the first pacing channel,record a test depolarization waveform when pacing pulses are delivered from the first and second pacing channels,compare the test depolarization waveform to the dual-channel capture template, the first channel capture template, and the second channel capture template,determine that both the first and second pacing channels have achieved capture if the test depolarization waveform matches the dual-channel capture template;
determine that the first pacing channel has failed to achieve capture if the test depolarization waveform does not match the dual-channel capture template but matches the second channel capture template,determine that the second pacing channel has failed to achieve capture if the test depolarization waveform does not match the dual-channel capture template but matches the first channel capture template, anddetermine that neither the first nor the second pacing channel has achieved capture if the test depolarization waveform matches neither the dual-channel capture template, the first channel capture template, nor the second channel capture template.
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Abstract
An apparatus and method for verifying capture by a pacing pulse in which a test depolarization waveform recorded during a pacing event is compared with a template waveform representing capture by the pacing pulse. Capture verification in this manner may be used in pacemakers having multiple pacing channels for the atrial and/or ventricles where the multiple paces can interfere with conventional sensing of evoked responses in order to verify capture.
122 Citations
19 Claims
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1. A system for determining capture thresholds for a multi-site cardiac pacemaker, comprising:
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a pacemaker having;
(a) first and second pacing channels with each such channel comprising an electrode for disposing new a chamber of the heart, a pulse generator for outputting pacing pulses, and a channel interface for adjusting the pacing pulse energy, (b) a controller for controlling the operation of the pulse generators in accordance with a programmed pacing mode such that first and second pacing pulses are delivered from the first and second pacing channels, respectively, to one or both of the paired atria or to one or both of the paired ventricles during a cardiac cycle, and (c) a telemetry interface for communicating with an external programmer;an external programmer having a controller for processing data received from the pacemaker, wherein the controller is programmed to; generate a dual-channel capture template by recording a depolarization waveform produced when first and second pacing pulses are delivered from the first and second pacing channels at an energy sufficient to achieve capture by each of the first and second pacing pulses, generate a first channel capture template by recording a depolarization waveform produced when first pacing pulses are delivered from the first pacing channel at an energy sufficient to achieve capture by the first pacing pulses with no pacing pulses delivered by the second pacing channel, generate a second channel capture template by recording a depolarization waveform produced when second pacing pulses are delivered from the second pacing channel at an energy sufficient to achieve capture by the second pacing pulses with no pacing pulses delivered by the first pacing channel, record a test depolarization waveform when pacing pulses are delivered from the first and second pacing channels, compare the test depolarization waveform to the dual-channel capture template, the first channel capture template, and the second channel capture template, determine that both the first and second pacing channels have achieved capture if the test depolarization waveform matches the dual-channel capture template; determine that the first pacing channel has failed to achieve capture if the test depolarization waveform does not match the dual-channel capture template but matches the second channel capture template, determine that the second pacing channel has failed to achieve capture if the test depolarization waveform does not match the dual-channel capture template but matches the first channel capture template, and determine that neither the first nor the second pacing channel has achieved capture if the test depolarization waveform matches neither the dual-channel capture template, the first channel capture template, nor the second channel capture template. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. A method for determining capture thresholds for a multi-site cardiac pacemaker, comprising:
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delivering first and second pacing pulses through first and second pacing channels, respectively, to either the atria or the ventricles during a cardiac cycle in accordance with a programmed pacing mode; generating a dual-channel capture template by recording a depolarization waveform produced when first and second pacing pulses are delivered from the first and second pacing channels at an energy sufficient to achieve capture by each of the first and second pacing pulses, generating a first channel capture template by recording a depolarization waveform produced when first pacing pulses are delivered from the first pacing channel at an energy sufficient to achieve capture by the first pacing pulses with no pacing pulses delivered by the second pacing channel, generating a second channel capture template by recording a depolarization waveform produced when second pacing pulses are delivered from the second pacing channel at an energy sufficient to achieve capture by the second pacing pulses with no pacing pulses delivered by the first pacing channel, recording a test depolarization waveform when pacing pulses are delivered from the first and second pacing channels, comparing the test depolarization waveform to the dual-channel capture template, the first channel capture template, and the second channel capture template, determining that both the first and second pacing channels have achieved capture if the test depolarization waveform matches the dual-channel capture template; determining that the first pacing channel has failed to achieve capture if the test depolarization waveform does not match the dual-channel capture template but matches the second channel capture template, determining that the second pacing channel has failed to achieve capture if the test depolarization waveform does not match the dual-channel capture template but matches the first channel capture template, and; determining that neither the first nor the second pacing channel has achieved capture if the test depolarization waveform matches neither the dual-channel capture template, the first channel capture template, nor the second channel capture template. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19)
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Specification