Endocardial pacing relating to conduction abnormalities

• US 8,010,192 B2
• Filed: 06/26/2008
• Issued: 08/30/2011
• Est. Priority Date: 12/20/2004
• Status: Active Grant

• Current Assignee: Newstim, Inc.
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhu, Qingsheng, Ortega, Daniel Felipe
• Primary Examiner(s): Layno; Carl H
• Assistant Examiner(s): Gedeon; Brian T
• Application Number:
  US12/147,369
• Publication Number:
  US 20090005830A1
• Time in Patent Office: 1,160 Days
• Field of Search: 607/9, 607/14, 607/25, 607/2, 607/4, 607/5
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

Various systems, methods and arrangements are implemented in connection with ventricular pacing. One such method relates to a method for use in connection with ventricular pacing of a left ventricle of a heart from a pacing lead located in the right ventricle. Ventricular function of the heart is sensed. The sensed ventricular function is used to determine whether a conduction abnormality exists. The ventricular pacing is provided in response to determining a conduction abnormality exists and the ventricular pacing is inhibited in response to determining a conduction abnormality does not exist.

Claims

1. A method for use in connection with ventricular pacing of a left ventricle of a heart from a pacing lead located in the right ventricle, the method comprising:

sensing ventricular function of the heart;

assessing the sensed ventricular function to determine whether a conduction abnormality exists, the assessing including declaring a conduction abnormality to exist when an intrinsic QRS width, measured in the absence of a delivered pacing pulse, exceeds a threshold value of at least 120 milliseconds;

providing the ventricular pacing, including at least partially concurrent opposite polarity pacing pulses at a right ventricular septum at or near a bundle of His, in response to determining a conduction abnormality exists; and

inhibiting the ventricular pacing, including at least partially concurrent opposite polarity pacing pulses at a right ventricular septum at or near a bundle of His, in response to determining a conduction abnormality does not exist.

2. The method of claim 1, wherein the step of providing the ventricular pacing is implemented using two concurrent pulses that are of opposite polarity to respective electrodes.

3. The method of claim 1, wherein the step of ventricular pacing is implemented by applying a pacing signal near a His bundle of the heart using concurrent opposite polarity pulses delivered at first and second electrodes that are separated from each other by about 4 mm.

4. The method of claim 1, wherein the step of assessing includes determining a fractionation.

5. The method of claim 1, wherein the step of assessing includes determining timing between activation of a late activation site of the left ventricle and a portion of a QRS complex.

6. The method of claim 1, wherein the step of assessing includes determining a maximum rate of change in pressure seen in the left ventricle.

7. A system for use in connection with ventricular pacing of a left ventricle of a heart from a pacing lead located in the right ventricle, the system comprising:

a sensor for sensing ventricular function of the heart;

a processing arrangement for assessing the sensed ventricular function to determine whether a conduction abnormality exists, the assessing including declaring a conduction abnormality to exist when an intrinsic QRS width, measured in the absence of a delivered pacing pulse, exceeds a threshold value of at least 120 milliseconds;

a pacing circuit for

providing the ventricular pacing, including at least partially concurrent opposite polarity pacing pulses at a right ventricular septum at or near a bundle of His, in response to determining a conduction abnormality exists; and

inhibiting the ventricular pacing, including at least partially concurrent opposite polarity pacing pulses at a right ventricular septum at or near a bundle of His, in response to determining a conduction abnormality does not exist.

8. The system of claim 7, wherein the system is arranged for implantation.

9. The system of claim 7, wherein the pacing circuit provides two concurrent pulses of opposite polarity to respective electrodes.

10. The system of claim 7, wherein the pacing is arranged to applying a pacing signal near a His bundle of the heart using concurrent opposite polarity pulses delivered at first and second electrodes that are separated from each other by about 4 mm.

11. The system of claim 7, wherein the sensor provides data used to determine fractionation.

12. The system of claim 7, wherein the sensor provides data used to determine timing between activation of a late activation site of the left ventricle and a portion of a QRS complex.

13. The system of claim 7, wherein the sensor provides data used to determine a maximum rate of change in pressure seen in the left ventricle.