Local and non-local sensing for cardiac pacing
First Claim
1. A method for delivery of pacing therapy to a heart by a patient-internal medical device (PIMD) that includes a pulse generator disposed in a patient-implantable housing that may be provided with a header, the method comprising:
- sensing, using body-implantable electrodes, at least one local cardiac electrical signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber and at least one non-local cardiac electrical signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the body-implantable electrodes including a non-local cardiac electrode pair that is used to sense the non-local cardiac electrical signal, the non-local cardiac electrode pair including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header;
sensing for a feature of the local signal corresponding to activation of the heart chamber;
sensing for a feature of the non-local signal corresponding to the activation of the heart chamber and including information about activation of a plurality of heart chambers; and
timing delivery of one or more pacing pulses based on a temporal relationship between timing of the feature of the local signal and timing of the feature of the non-local signal;
wherein the method is carried out on a beat-by-beat basis, such that the sensing for the feature of the local signal, the sensing for the feature of the non-local signal, and the timing delivery of a given one of the one or more pacing pulses are all associated with a given cardiac beat.
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Abstract
Systems and methods for determining pacing timing intervals based on the temporal relationship between the timing of local and non-local cardiac signal features are described. A device includes a plurality of implantable electrodes electrically coupled to the heart and configured to sense local and non-local cardiac signals. Sense circuitry coupled to first and second electrode pairs senses a local cardiac signal via a first electrode pair and a non-local cardiac signal via a second electrode pair. Detection circuitry is used to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber. A control processor times delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature.
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Citations
21 Claims
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1. A method for delivery of pacing therapy to a heart by a patient-internal medical device (PIMD) that includes a pulse generator disposed in a patient-implantable housing that may be provided with a header, the method comprising:
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sensing, using body-implantable electrodes, at least one local cardiac electrical signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber and at least one non-local cardiac electrical signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the body-implantable electrodes including a non-local cardiac electrode pair that is used to sense the non-local cardiac electrical signal, the non-local cardiac electrode pair including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header; sensing for a feature of the local signal corresponding to activation of the heart chamber; sensing for a feature of the non-local signal corresponding to the activation of the heart chamber and including information about activation of a plurality of heart chambers; and timing delivery of one or more pacing pulses based on a temporal relationship between timing of the feature of the local signal and timing of the feature of the non-local signal; wherein the method is carried out on a beat-by-beat basis, such that the sensing for the feature of the local signal, the sensing for the feature of the non-local signal, and the timing delivery of a given one of the one or more pacing pulses are all associated with a given cardiac beat. - View Dependent Claims (2, 3, 4, 5)
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6. A method for delivery of pacing therapy, comprising:
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sensing, using body-implantable electrodes, at least one local cardiac electrical signal and at least one non-local cardiac electrical signal; sensing for a feature of the local signal corresponding to activation of a heart chamber; sensing for a feature of the non-local signal corresponding to activation of the heart chamber; and timing delivery of one or more pacing pulses based on a temporal relationship between timing of the feature of the local signal and timing of the feature of the non-local signal; wherein the body-implantable electrodes include a first electrode positioned in or on an implantable housing or header and a second electrode positioned in or on the implantable housing or header, the first and second electrodes being used for sensing for the feature of the non-local signal; and wherein timing the delivery of the pacing pulses comprises; triggering delivery of a pacing pulse based on the non-local feature if the non-local feature is detected; and triggering delivery of the pacing pulse based on the local feature if the non-local feature is not detected. - View Dependent Claims (7, 8)
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9. An implantable cardiac rhythm management device, comprising:
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a patient-internal medical device (PIMD) including a pulse generator disposed in a patient-implantable housing that may be provided with a header; a plurality of implantable electrodes coupled to the housing and configured to electrically couple to a heart, at least a first pair of the plurality of electrodes configured to sense a local cardiac signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber and at least a second pair of the plurality of electrodes configured to sense a non-local cardiac signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the second pair of electrodes including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header; sense circuitry coupled to the first and second electrode pairs and configured to sense the local cardiac signal via the first electrode pair and the non-local cardiac signal via the second electrode pair; detection circuitry configured to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber; and a control processor configured to time delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature; wherein the device is configured to operate on a beat-by-beat basis, such that the control processor is configured to deliver a given one of the one or more pacing pulses during a same cardiac beat in which the sense circuitry senses the local cardiac signal and the non-local cardiac signal. - View Dependent Claims (10, 11, 12, 13, 14, 15)
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16. An implantable cardiac rhythm management device, comprising:
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a plurality of implantable electrodes configured to electrically couple to a heart, the plurality of implantable electrodes including at least a first pair of electrodes and a second pair of electrodes; sense circuitry coupled to the first and second electrode pairs and configured to sense a local cardiac signal via the first electrode pair and a non-local cardiac signal via the second electrode pair; detection circuitry configured to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber; and a control processor configured to time delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature; wherein the control processor is configured to trigger pacing based on the timing of the non-local signal feature if the non-local signal feature is detected and to trigger pacing based on the timing of the local signal feature if the non-local signal feature is not detected. - View Dependent Claims (17, 18)
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19. A system for delivery of pacing therapy to a heart, comprising:
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a patient-internal medical device (PIMD) including a pulse generator disposed in a patient-implantable housing that may be provided with a header; a first pair of body-implantable electrodes coupled to the housing and configured to sense a local cardiac signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber; a second pair of body-implantable electrodes coupled to the housing and configured to sense a non-local cardiac signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the second pair of electrodes including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header; means for detecting a feature of the local signal related to activation of a cardiac chamber; means for detecting a feature of the non-local signal related to activation of the cardiac chamber and including information about activation of a plurality of heart chambers; and means for timing delivery of one or more pacing pulses based on a temporal relationship between timing of the local feature and timing of the non-local feature; wherein the device is configured to operate on a beat-by-beat basis, such that the timing means is configured to deliver a given one of the one or more pacing pulses during a same cardiac beat in which the first and second pairs of body-implantable electrodes sense the local and non-local cardiac signals respectively. - View Dependent Claims (20, 21)
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Specification