Automatic selection of stimulation chamber for ventricular resynchronization therapy

• US 9,061,156 B2
• Filed: 07/17/2014
• Issued: 06/23/2015
• Est. Priority Date: 12/15/2000
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Ding, Jiang, Spinelli, Julio C., Yu, Yinghong, Kramer, Andrew P.
• Primary Examiner(s): PATTON, AMANDA K
• Application Number:
  US14/333,674
• Publication Number:
  US 20140330330A1
• Time in Patent Office: 341 Days
• Field of Search: 607/9, 607/30
• US Class Current: 1/1
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• 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 1/36592 controlled by the heart rate variability
• 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 method and apparatus for selection of one or more ventricular chambers to stimulate for ventricular resynchronization therapy. Intrinsic intracardia electrograms that include QRS complexes, are recorded from a left and right ventricle. A timing relationship between the intrinsic intracardia electrograms recorded from the left and right ventricle is then determined. In one embodiment, the timing relationship is determined using a delay between a left ventricular and a right ventricular sensed intrinsic ventricular depolarizations and a duration interval of one or more QRS complexes. In one embodiment, the duration of QRS complexes is determined from either intracardiac electrograms or from surface ECG recordings. One or more ventricular chambers in which to provide pacing pulses are then selected based on the timing relationship between intrinsic intracardia electrograms recorded from the right and left ventricle, and the duration of one or more QRS complexes.

Claims

1. An implantable cardiac device, comprising:

sensing circuitry for receiving cardiac signals from the right and left ventricles;

pacing circuitry for delivering pacing pulses;

a controller for controlling the operation of the pacing circuitry in accordance with a selected pacing mode;

circuitry for determining a timing relationship between intrinsic ventricular depolarizations of the left and the right ventricles; and

,

circuitry for selecting between a right ventricular, left ventricular, or biventricular pacing mode by which to provide pacing pulses based on the timing relationship between intrinsic ventricular depolarizations of the left and the right ventricle, wherein the selected pacing mode determines the manner in which paces are delivered over multiple cardiac cycles.

2. The device of claim 1 wherein the timing relationship between intrinsic ventricular depolarizations of the left and the right ventricle is derived from intracardiac electrograms received by the sensing circuitry.

3. The device of claim 1 wherein the timing relationship between intrinsic ventricular depolarizations of the left and the right ventricle includes an interval between a right ventricular sense R_R and a left ventricular sense L_L.

4. The device of claim 1 further comprising:

a receiver/transmitter circuit for communicating with an external device and wherein the circuitry for selecting between a right ventricular, left ventricular, or biventricular pacing mode by which to provide pacing pulses further bases the selection on a QRS duration received from the external device.

5. The device of claim 1 wherein the circuitry for selecting between a right ventricular, left ventricular, or biventricular pacing mode by which to provide pacing pulses includes circuitry for selecting pacing in the left ventricle when the delay between the right ventricular and the left ventricular intrinsic ventricular depolarizations is greater than a threshold value, with the right ventricular depolarization occurring before the left ventricular depolarization.

6. The device of claim 5 wherein the threshold value is zero (0).

7. The device of claim 1 wherein the circuitry for selecting between a right ventricular, left ventricular, or biventricular pacing mode by which to provide pacing pulses includes circuitry for selecting pacing in the right and left ventricles when the delay between the right ventricular and the left ventricular intrinsic ventricular depolarizations is greater than a threshold value, with the right ventricular depolarization occurring before the left ventricular depolarization.

8. The device of claim 7 wherein the threshold value is zero (0).

9. The device of claim 1 wherein the circuitry for selecting between a right ventricular, left ventricular, or biventricular pacing mode by which to provide pacing pulses includes circuitry for selecting pacing in the right ventricle when the delay between the left ventricular and the right ventricular intrinsic ventricular depolarizations is greater than a threshold value, with the left ventricular depolarization occurring before the right ventricular depolarization.

10. The device of claim 9 wherein the threshold value is zero (0).

11. A method for operating an implantable cardiac device, comprising:

receiving cardiac signals from the right and left ventricles;

delivering pacing pulses in accordance with a selected pacing mode;

determining a timing relationship between intrinsic ventricular depolarizations of the left and the right ventricles; and

,

selecting between a right ventricular, left ventricular, or biventricular pacing mode by which to provide pacing pulses based on the timing relationship between intrinsic ventricular depolarizations of the left and the right ventricle, wherein the selected pacing mode determines the manner in which paces are delivered over multiple cardiac cycles.

12. The method of claim 11 wherein the timing relationship between intrinsic ventricular depolarizations of the left and the right ventricle is derived from intracardiac electrograms received by the sensing circuitry.

13. The method of claim 11 wherein the timing relationship between intrinsic ventricular depolarizations of the left and the right ventricle includes an interval between a right ventricular sense R_R and a left ventricular sense L_L.

14. The method of claim 11 further comprising selecting between a right ventricular, left ventricular, or biventricular pacing mode by which to provide pacing pulses where the selection is further based on a QRS duration received from an external device.

15. The method of claim 11 further comprising electing pacing in the left ventricle when the delay between the right ventricular and the left ventricular intrinsic ventricular depolarizations is greater than a threshold value, with the right ventricular depolarization occurring before the left ventricular depolarization.

16. The method of claim 15 wherein the threshold value is zero (0).

17. The method of claim 11 further comprising selecting pacing in the right and left ventricles when the delay between the right ventricular and the left ventricular intrinsic ventricular depolarizations is greater than a threshold value, with the right ventricular depolarization occurring before the left ventricular depolarization.

18. The method of claim 17 wherein the threshold value is zero (0).

19. The method of claim 11 further comprising selecting pacing in the right ventricle when the delay between the left ventricular and the right ventricular intrinsic ventricular depolarizations is greater than a threshold value, with the left ventricular depolarization occurring before the right ventricular depolarization.

20. The method of claim 19 wherein the threshold value is zero (0).