Identification of abnormal cardiac substrate during left-ventricular pacing
First Claim
1. A system for identifying abnormal cardiac substrate, the system comprising:
- at least one implantable left-ventricular (LV) lead comprising a plurality of electrodes, wherein the plurality of electrodes includes at least one bipolar electrode pair configured to sense a LV bipolar cardiac electrogram signal of LV tissue proximate the bipolar electrode pair;
a signal generator configured to deliver cardiac pacing pulses to a left ventricle via at least one electrode of the plurality of electrodes of the at least one LV lead,wherein the bipolar electrode pair does not include the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle, andwherein a distance from the bipolar electrode pair to the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle is greater than or equal to approximately ten millimeters; and
a cardiac tissue analysis module configured to;
determine an amplitude of a depolarization within the LV bipolar cardiac electrogram signal, the depolarization resulting from the delivery of cardiac pacing pulses to the left ventricle, wherein the amplitude indicates whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate; and
provide an indication of whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate based on the amplitude.
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Accused Products
Abstract
Techniques for identifying abnormal cardiac substrate, e.g., scar substrate, may be implemented, as an example, during implantation of a left-ventricular (LV) lead, e.g., for cardiac resynchronization therapy (CRT), which may enable placement of the LV lead to avoid the abnormal cardiac substrate. An example system for identifying abnormal cardiac substrate comprises at least one implantable LV lead comprising at least one bipolar electrode pair configured to sense a LV bipolar cardiac electrogram signal of LV tissue proximate the bipolar electrode pair. The system delivers cardiac pacing pulses to a left ventricle via at least one electrodes of the LV lead, which may be different then the electrodes of the bipolar pair, and which may be spaced at least a threshold distance from the bipolar pair of electrodes. The amplitude of paced depolarizations in the bipolar electrogram indicates whether tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate.
31 Citations
27 Claims
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1. A system for identifying abnormal cardiac substrate, the system comprising:
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at least one implantable left-ventricular (LV) lead comprising a plurality of electrodes, wherein the plurality of electrodes includes at least one bipolar electrode pair configured to sense a LV bipolar cardiac electrogram signal of LV tissue proximate the bipolar electrode pair; a signal generator configured to deliver cardiac pacing pulses to a left ventricle via at least one electrode of the plurality of electrodes of the at least one LV lead, wherein the bipolar electrode pair does not include the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle, and wherein a distance from the bipolar electrode pair to the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle is greater than or equal to approximately ten millimeters; and a cardiac tissue analysis module configured to; determine an amplitude of a depolarization within the LV bipolar cardiac electrogram signal, the depolarization resulting from the delivery of cardiac pacing pulses to the left ventricle, wherein the amplitude indicates whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate; and provide an indication of whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate based on the amplitude. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. A method for identifying abnormal cardiac substrate, the method comprising:
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sensing, by a bipolar electrode pair, a left-ventricular (LV) bipolar cardiac electrogram signal of LV tissue proximate the bipolar electrode pair, wherein at least one implanted LV lead comprises a plurality of electrodes, and the plurality of electrodes includes the bipolar electrode pair; delivering, by a signal generator, cardiac pacing pulses to a left ventricle via at least one electrode of the plurality of electrodes of the at least one LV lead, wherein the bipolar electrode pair does not include the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle, and wherein a distance from the bipolar electrode pair to the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle is greater than or equal to approximately ten millimeters; determining, by a cardiac tissue analysis module, an amplitude of a depolarization within the LV bipolar cardiac electrogram signal, the depolarization resulting from the delivery of cardiac pacing pulses to the left ventricle, wherein the amplitude indicates whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate; and providing, by the cardiac tissue analysis module, an indication of whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate based on the amplitude. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21, 22, 23, 24)
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25. A system for identifying abnormal cardiac substrate, the system comprising:
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means for sensing, via a bipolar electrode pair, a left-ventricular (LV) bipolar cardiac electrogram signal of LV tissue proximate the bipolar electrode pair, wherein at least one implantable LV lead comprises a plurality of electrodes, and the plurality of electrodes includes the bipolar electrode pair; means for delivering cardiac pacing pulses to a left ventricle via at least one electrode of the plurality of electrodes of the at least one LV lead, wherein the bipolar electrode pair does not include the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing to the left ventricle, and wherein a distance from the bipolar electrode pair to the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle is greater than or equal to approximately ten millimeters; means for determining an amplitude of a depolarization within the LV bipolar cardiac electrogram signal, the depolarization resulting from the delivery of cardiac pacing pulses to the left ventricle, wherein the amplitude indicates whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate; and means for providing an indication of whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate based on the amplitude.
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26. A non-transitory computer-readable storage medium comprising instructions that, when executed by at least one processor, cause the at least one processor to:
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receive, via a bipolar electrode pair, a left-ventricular (LV) bipolar cardiac electrogram signal of LV tissue proximate the bipolar electrode pair, wherein at least one implantable LV lead comprises a plurality of electrodes, and the plurality of electrodes includes the bipolar electrode pair; determine an amplitude of a depolarization within the LV bipolar cardiac electrogram signal, the depolarization resulting from the delivery of cardiac pacing pulses to a left ventricle via at least one electrode of the plurality of electrodes of the at least one LV lead, wherein the bipolar electrode pair does not include the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle, wherein a distance from the bipolar electrode pair to the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle is greater than or equal to approximately ten millimeters, and wherein the amplitude indicates whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate; and provide an indication of whether the LV tissue proximate the bipolar electrode pair comprises abnormal cardiac substrate based on the amplitude.
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27. A system for identifying abnormal cardiac substrate, the system comprising:
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at least one implantable left-ventricular (LV) lead comprising a plurality of electrodes, wherein the plurality of electrodes includes at least one bipolar electrode pair configured to sense a LV bipolar cardiac electrogram signal of LV tissue proximate the bipolar electrode pair, wherein the bipolar pair of electrodes comprises an inter-electrode spacing that is less than or equal to approximately two millimeters; a signal generator configured to deliver cardiac pacing pulses to a left ventricle via at least one electrode of the plurality of electrodes of the at least one LV lead, wherein the bipolar electrode pair does not include the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle, and a distance from the bipolar electrode pair to the at least one electrode of the plurality of electrodes via which the signal generator is configured to deliver cardiac pacing pulses to the left ventricle is greater than or equal to approximately ten millimeters; a cardiac tissue analysis module configured to determine whether an amplitude of a depolarization within the LV bipolar cardiac electrogram signal resulting from the delivery of cardiac pacing pulses to the left ventricle is less than a threshold; and a user interface configured to indicate that the LV tissue proximate the bipolar electrode pair comprises scar substrate in response to the amplitude being less than the threshold.
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Specification