Cardiac rhythm management system selecting between multiple same-chamber electrodes for delivering cardiac therapy

• US 8,600,498 B2
• Filed: 10/07/2012
• Issued: 12/03/2013
• Est. Priority Date: 05/23/2001
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ding, Jiang, Spinelli, Julio C., Kramer, Andrew P.
• Primary Examiner(s): EVANISKO, GEORGE ROBERT
• Application Number:
  US13/646,720
• Publication Number:
  US 20130030485A1
• Time in Patent Office: 422 Days
• Field of Search: 607/9, 607/14, 607/15
• 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
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A cardiac rhythm management system selects one of multiple electrodes associated with a particular heart chamber based on a relative timing between detection of a depolarization fiducial point at the multiple electrodes, or based on a delay between detection of a depolarization fiducial point at the multiple electrodes and detection of a reference depolarization fiducial point at another electrode associated with the same or a different heart chamber. Subsequent contraction-evoking stimulation therapy is delivered from the selected electrode.

Claims

1. A system comprising:

a sensing module configured to detect, from a first location, a first depolarization fiducial corresponding to a depolarization of a first heart chamber, and further configured to detect, from a different second location, a second depolarization fiducial corresponding to a depolarization of the first heart chamber; and

a controller, coupled to the sensing module, the controller configured to determine whether the first or second depolarization fiducial occurs earlier in a cardiac cycle;

wherein the controller is configured to indicate, for an electrostimulation therapy, an electrostimulation electrode configuration that includes an electrostimulation electrode corresponding to the different second location and precludes an electrostimulation electrode corresponding to the first location when the first depolarization fiducial occurs earlier in the cardiac cycle than the second depolarization fiducial; and

wherein the controller is further configured to indicate, for an electrostimulation therapy, an electrostimulation electrode configuration that includes an electrostimulation electrode corresponding to the first location and precludes an electrostimulation electrode corresponding to the different second location when the second depolarization fiducial occurs earlier in the cardiac cycle than the first depolarization fiducial.

2. The system of claim 1, further comprising the electrostimulation electrode corresponding to the different second location;

wherein the controller is configured to indicate, for the electrostimulation therapy, an electrostimulation electrode configuration that uses the electrostimulation electrode corresponding to the different second location when the first depolarization fiducial occurs earlier in the same cardiac cycle than the second depolarization fiducial.

3. The system of claim 1, further comprising the electrostimulation electrode corresponding to the first location;

wherein the controller is configured to indicate, for the electrostimulation therapy, an electrostimulation electrode configuration that uses an electrostimulation electrode corresponding to the first location when the second depolarization fiducial occurs earlier in the same cardiac cycle than the first depolarization fiducial.

4. The system of claim 1, further comprising a first electrostimulation electrode configured to be disposed at the first location and associated with the first heart chamber, and a second electrostimulation electrode configured to be disposed at the different second location and associated with the first heart chamber.

5. The system of claim 4, wherein the first electrode is configured to be disposed at one of a base, midregion, or apex of a free wall of a heart ventricle, and wherein the second electrode is disposed at a different one of the base, midregion, or apex of the free wall of the heart ventricle.

6. The system of claim 1, wherein the sensing module is configured to detect, as the first depolarization fiducial corresponding to a depolarization of the first heart chamber, a depolarization fiducial corresponding to one of a left ventricle and a right ventricle.

7. The system of claim 1, further comprising:

a first electrostimulation electrode disposed at the first location;

a second electrostimulation electrode disposed at the second location; and

a therapy circuit configured to deliver an electrostimulation for evoking a heart contraction using one of the first and second electrostimulation electrodes, wherein the controller selectively couples the therapy circuit to the first and second electrostimulation electrodes.

8. The system of claim 1, wherein the sensing module is configured to provide, over a plurality of cardiac cycles, a plurality of first depolarization fiducials and a plurality of second depolarization fiducials, and wherein the controller is configured to compute a first statistic using the plurality of first depolarization fiducials and a second statistic using the plurality of second depolarization fiducials, and wherein the controller is configured to compare the first and second statistics and provide an indication of an electrostimulation electrode configuration for an electrostimulation therapy using the comparison of the first and second statistics.

9. The system of claim 8, wherein the controller is configured to indicate the electrostimulation electrode configuration for the electrostimulation therapy that uses an electrostimulation electrode corresponding to the different second location when the plurality of first depolarization fiducials statistically occur earlier in a cardiac cycle than the plurality of second depolarization fiducials, and the controller is further configured to indicate the electrostimulation electrode configuration that uses an electrostimulation electrode corresponding to the first location when the plurality of second depolarization fiducials statistically occur earlier in a cardiac cycle than the plurality of first depolarization fiducials.

10. The system of claim 9, wherein the controller is configured to indicate an electrostimulation electrode configuration for the electrostimulation therapy that uses an electrostimulation electrode corresponding to the first or second location that is closer to a heart apex when the first and second depolarization fiducials statistically occur at approximately the same time.

11. The system of claim 1, wherein the controller is configured to indicate, for the electrostimulation therapy, an electrostimulation electrode configuration that uses an electrostimulation electrode corresponding to the first location when the second depolarization fiducial occurs earlier in the cardiac cycle than the first depolarization fiducial by at least a specified threshold amount of time, wherein the controller is configured to indicate, for the electrostimulation therapy, an electrostimulation electrode configuration that uses an electrostimulation electrode corresponding to the second location when the first depolarization fiducial occurs earlier in the cardiac cycle than the second depolarization fiducial by at least a specified threshold amount of time, and wherein the controller is configured to otherwise indicate, for the electrostimulation therapy, an electrostimulation electrode configuration that uses an electrostimulation electrode location corresponding to the first or second location that is closer to a heart apex.

12. The system of claim 1, further comprising a local or remote external programmer, configured to be communicatively coupled to the controller, the external programmer configured to display an indication of the electrostimulation electrode configuration indicated by the controller.

13. The system of claim 1, wherein the sensing module is configured to detect, as the first depolarization fiducial, one of a peak of an R-wave in a QRS complex or an onset of the QRS complex.

14. A system comprising:

an implantable cardiac function management device comprising;

a sensing module configured to detect, from a first location, a first depolarization fiducial corresponding to a depolarization of a first heart chamber, and further configured to detect, from a different second location, a second depolarization fiducial corresponding to a depolarization of the first heart chamber; and

a controller, coupled to the sensing module, the controller configured to provide an indication of whether the second depolarization fiducial occurs earlier in a cardiac cycle than the first depolarization fiducial, and, when the second depolarization fiducial occurs earlier in the cardiac cycle, the controller is configured to indicate, for an electrostimulation therapy, an electrostimulation electrode configuration for use with an electrostimulation electrode at or near the first location and preclude from use an electrostimulation electrode corresponding to the second location, and, when the first depolarization fiducial occurs earlier in the cardiac cycle, the controller is configured to indicate, for the electrostimulation therapy, an electrostimulation electrode configuration for use with an electrostimulation electrode at or near the second location and preclude from use an electrostimulation electrode corresponding to the first location.

15. The system of claim 14, further comprising a local or remote external programmer, configured to be communicatively coupled to the controller, the external programmer configured to display an indication of the electrostimulation electrode configuration indicated by the controller.

16. The system of claim 14, further comprising a first electrode configured to be disposed at the first location and associated with the first heart chamber, and a second electrode configured to be disposed at the different second location and associated with the first heart chamber.

17. The system of claim 16, wherein the first and second electrodes are configured to be associated with one of a left or right ventricle.

18. A system comprising:

a sensing circuit, configured to be coupled to first and second electrodes that are associated with a first heart chamber, the sensing circuit configured to detect heart depolarizations associated with the first heart chamber, the sensing circuit further configured to detect a first depolarization time at which a first depolarization of the first heart chamber is received at the first electrode, and to detect a second depolarization time at which the same first depolarization of the first heart chamber is received at the second electrode; and

a controller, coupled to the sensing circuit, the controller configured to determine whether the first depolarization time occurs earlier in a cardiac cycle than the second depolarization time, and the controller configured to indicate for use in an electrostimulation therapy the second electrode and preclude from use the first electrode when the first depolarization time occurs earlier in the cardiac cycle than the second depolarization time, and the controller further configured to indicate for use in the electrostimulation therapy the first electrode and preclude from use the second electrode when the second depolarization time occurs earlier in the cardiac cycle than the first depolarization time; and

a local or remote external programmer, communicatively coupled to the controller, the remote programmer configured to display an indication of the first or second electrode indicated for use in the electrostimulation therapy by the controller.

19. The system of claim 18, further comprising the first and second electrodes, wherein the first and second electrodes are configured to be associated with one of a left or right ventricle.