Apparatus for treating the physiological electric conduction of the heart

• US 8,437,848 B2
• Filed: 10/10/2008
• Issued: 05/07/2013
• Est. Priority Date: 12/20/2004
• Status: Active Grant

• Current Assignee: Newstim, Inc.
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ortega, Daniel Felipe, Giniger, Alberto German
• Primary Examiner(s): DIETRICH, JOSEPH M
• Application Number:
  US12/249,479
• Publication Number:
  US 20090093859A1
• Time in Patent Office: 1,670 Days
• Field of Search: 607/9, 607/11, 607/15, 607/36, 607/122
• US Class Current: 607/9
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• 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 1/371 Capture, i.e. successful stimulation

Abstract

A new pacemaker apparatus for treating the physiological electric conduction of the heart that includes a conduction abnormality in a ventricle. The pacemaker includes a pulse generator and a pacing electrode located in the heart, the pulse generator providing pacing signals to the pacing electrode. The pacemaker further includes a signal generation circuit that generates electrical signals from heart-related feedback signals that indicate that the pacing electrode is delivering the pacing signals in a region at or near the His bundle of the heart. The combination of the pulse generator and the signal generation circuit indicates that the pacing electrode is delivering the pacing signals in the region, at or near the His bundle of the heart, to electrically bypass the conduction abnormality of the heart in the ventricle.

Claims

1. An apparatus comprising:

a pulse generator configured to provide electrostimulation pulses to a first electrode and a second electrode at or near a His bundle of a heart, the electrostimulation pulses comprising at least partially concurrent opposite polarity signals, wherein the electrostimulation pulses comprise a first monopolar pulse delivered from the first electrode with respect to a reference and a second monopolar pulse delivered from the second electrode with respect to the reference and

a cardiac activity monitoring circuit configured to monitor heart-related feedback indicative that a conduction abnormality of the heart is electrically bypassed during a heart contraction elicited by the electrostimulation pulses.

2. The apparatus of claim 1, further including a medium retaining data that indicates the electrode is delivering the electrostimulation pulses in the region, at or near the His bundle of the heart, to elicit the heart contraction that electrically bypasses the conduction abnormality of the heart.

3. The apparatus of claim 1, wherein the cardiac activity monitoring circuit includes an electrocardiograph (ECG) apparatus.

4. The apparatus of claim 1, wherein the cardiac activity monitoring circuit includes a sensor for indicating a delay between a beginning of a QRS complex and an activation of the left ventricle free wall at a point distal from the Apex of the left ventricle.

5. The apparatus of claim 3, wherein the ECG apparatus is configured to display a QRS width using information provided by the cardiac monitoring circuit to indicate that the pacing electrode is delivering the pacing signals in the region, at or near the His bundle of the heart, to elicit the heart contraction that electrically bypasses the conduction abnormality of the heart.

6. The apparatus of claim 3, wherein the ECG apparatus is configured to display depolarization-repolarization patterns monitored by the cardiac monitoring circuit to indicate that the pacing electrode is delivering the pacing signals in the region, at or near the His bundle of the heart, to elicit the heart contraction that electrically bypasses the conduction abnormality of the heart.

7. The apparatus of claim 1, further comprising a sensing electrode to carry the heart-related feedback signals.

8. The apparatus of claim 7, wherein the sensing electrode is one of the first or second electrodes.

9. The apparatus of claim 7, wherein the sensing electrode includes an electrode separate from the first or second electrodes and is located in the coronary sinus.

10. The apparatus of claim 1, further including a catheter to deliver the first and second electrodes to the heart ventricle.

11. The apparatus of claim 1, further including a guide sheath to guide the first and second electrodes to the region at or near the His bundle of the heart.

12. The apparatus of claim 11, wherein the guide sheath is deflectable to guide the first and second electrodes to the region at or near the His bundle of the heart.

13. The apparatus of claim 1, wherein the conduction abnormality includes a bundle branch block.

14. The apparatus of claim 1, wherein the conduction abnormality includes a ventricular conduction abnormality.

15. The apparatus of claim 1, wherein the cardiac monitoring circuit includes a cardiac electrogram monitoring circuit included as a portion of an implantable device.

16. A method comprising:

generating electrostimulation pulses for delivery to a location at or near a His bundle of a heart, the electrostimulation pulses comprising at least partially concurrent opposite polarity signals, wherein the electrostimulation pulses comprise a first monopolar pulse delivered from a first electrode with respect to a reference and a second monopolar pulse delivered from a second electrode with respect to the reference

monitoring heart signals to determine that a conduction abnormality of the heart is electrically bypassed during a heart contracting elicited in response to the electrostimulation pulses.

17. The method of claim 16, wherein monitoring heart signals to determine that a conduction abnormality of the heart is electrically bypassed in response to the electrostimulation pulses comprises using an ECG apparatus.

18. The method of claim 16, wherein monitoring heart signals to determine that a conduction abnormality of the heart is electrically bypassed in response to the electrostimulation pulses comprises using an Egram.

19. The method of claim 16, wherein monitoring heart signals includes measuring a delay between a beginning of a QRS complex and an activation of the left ventricle free wall at a point distal from the Apex of the left ventricle.

20. The method of claim 16, wherein monitoring heart signals includes monitoring a QRS width and displaying it on an electrocardiograph display to indicate that a pacing electrode is delivering the electrostimulation pulses in the region, at or near the His bundle of the heart, to elicit the heart contraction that electrically bypasses the conduction abnormality of the heart.

21. The method of claim 16, wherein monitoring heart signals includes monitoring depolarization-repolarization patterns and displaying the depolarization-repolarization patterns on an electrocardiograph display to indicate that the pacing electrode is delivering the pacing signals in the region, at or near the His bundle of the heart, to elicit the heart contraction that electrically bypasses the conduction abnormality of the heart.

22. The method of claim 16, wherein the heart signals are monitored by a sensing electrode.

23. The method of claim 22, wherein the sensing electrode is one of the first and second electrodes.

24. The method of claim 22, wherein the sensing electrode is located in the coronary sinus and is not one of the first and second electrodes.

25. The method of claim 16, further comprising using a catheter to deliver the first and second electrodes to a heart ventricle to deliver the electrostimulation pulses.

26. The method of claim 16, further comprising using a guide sheath to guide the first and second electrodes to a region at or near the His bundle of the heart.

27. The apparatus of claim 26, wherein the guide sheath is deflectable to guide the first and second electrode to the region at or near the His bundle of the heart.