System and method for assessing and selecting stimulation vectors in an implantable cardiac resynchronization therapy device

• US 9,457,191 B2
• Filed: 12/18/2014
• Issued: 10/04/2016
• Est. Priority Date: 12/18/2013
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Yu, Yinghong, Herrmann, Keith L., Rockweiler, Holly E., Saha, Sunipa, Nyquist, Benjamin J.
• Primary Examiner(s): Schaetzle, Kennedy
• Application Number:
  US14/574,787
• Publication Number:
  US 20150165204A1
• Time in Patent Office: 656 Days
• Field of Search: None
• US Class Current: 1/1
• 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 1/3686 configured for selecting the electrode configuration on a lead A61N1/3688 takes precedence
• CPC Class Codes: A61N 1/37247 User interfaces, e.g. input or presentation means
• CPC Class Codes: G16H 20/00 ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/63 for local operation

Abstract

Systems and methods for providing CRT therapy to a patient with an implanted multi-site pacing medical device. In one example, an intrinsic electrical delay associated with each of two or more left ventricle electrodes may be determined. The intrinsic electrical delay associated with each of the two or more left ventricle electrodes may be compared to an electrical delay threshold. If the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, a single left ventricle electrode may be selected for use during subsequent CRT therapy. If the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, two or more of the left ventricle electrodes may be selected for use during subsequent CRT therapy.

Claims

1. A method of providing CRT therapy to a patient with an implanted multi-site pacing medical device, wherein the method comprises:

determining an electrical delay associated with each of two or more left ventricle electrodes, wherein each of the two or more left ventricle electrodes is included in a different stimulation vector which includes an anode and a cathode, and wherein the electrical delay is a measure of time delay between delivery of electrical stimulation to one of a cathode or anode of a stimulation vector and detecting the electrical stimulation at the other of the anode or cathode of the stimulation vector;

comparing the electrical delay associated with each of the two or more left ventricle electrodes to an electrical delay threshold;

if the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, selecting a left ventricle electrode for use during subsequent CRT therapy; and

if the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, selecting two or more of the left ventricle electrodes for use during subsequent CRT therapy.

2. The method of claim 1, wherein:

if the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, selecting the left ventricle electrode with the longest associated electrical delay for use during subsequent CRT therapy.

3. The method of claim 1, wherein:

if the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, selecting two or more of the left ventricle electrodes that have associated electrical delays that are greater than the electrical delay threshold for use during subsequent CRT therapy.

4. The method of claim 3, wherein the two or more of the left ventricle electrodes that are selected for use during subsequent CRT therapy are each paced as cathodes during subsequent CRT therapy.

5. The method of claim 3, wherein at least one of the two or more of the left ventricle electrodes that are selected for use during subsequent CRT therapy is paced as an anode and at least one of the two or more of the left ventricle electrodes is paced as a cathode.

6. The method of claim 1, wherein:

if the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, providing a pacing offset between pacing pulses of at least two of the two or more left ventricle electrodes during subsequent CRT therapy.

7. The method of claim 6, wherein the pacing offset between pacing pulses of at least two of the two or more left ventricle electrodes is related to the difference of electrical delays between the at least two of the two or more electrodes.

8. The method of claim 1, wherein the method is initiated at a predetermined interval.

9. The method of claim 1, wherein the method is initiated by a trigger.

10. The method of claim 9, further comprising issuing the trigger when the electrical delay associated with at least one of the two or more left ventricle electrodes changes by more than a predetermined amount.

11. The method of claim 9, wherein the trigger is dependent upon an activity level of the patient.

12. The method of claim 1, wherein the electrical delay associated with each of the two or more left ventricle electrodes corresponds to a QLV delay.

13. The method of claim 1, wherein the electrical delay associated with each of the two or more left ventricle electrodes corresponds to a RV-LV delay.

14. The method of claim 1, further comprising:

evaluating a physical spacing between the selected two or more of the left ventricle electrodes, and if two or more of the selected electrodes are within a threshold electrode spacing of each other, deselecting all but one of those electrodes for use during subsequent CRT therapy.

15. A method of providing CRT therapy to a patient with an implanted multi-site pacing medical device, wherein the method comprises:

sensing an electrical delay between a pair of electrodes for each of a plurality of electrode pairs, wherein the pair of electrodes include an anode and a cathode of a stimulation vector, and wherein the electrical delay is a time delay between delivery of electrical stimulation to one of the anode or cathode of the stimulation vector and detecting the electrical stimulation at the other of the cathode or anode of the stimulation vector;

comparing the sensed electrical delay of each of the plurality of electrode pairs to an electrical delay threshold;

if the sensed electrical delay of one or fewer electrode pairs is greater than the electrical delay threshold, selecting a single electrode to act as a cathode for subsequent CRT therapy; and

if the sensed electrical delay of more than one electrode pair is greater than the electrical delay threshold, selecting two or more electrodes to each act as a cathode during subsequent CRT therapy.

16. The method of claim 15, wherein selecting two or more electrodes to each act as a cathode further comprises deselecting at least one of the two or more electrodes if a spacing between at least two of the two or more electrodes is less than a threshold electrode spacing.

17. A medical device system for providing CRT therapy to a patient, comprising:

a pulse generator;

two or more left ventricle electrodes operatively coupled to the pulse generator, wherein each electrode of the two or more left ventricle electrodes is included in a different stimulation vector that includes an anode and a cathode;

a controller, wherein the controller is configured to;

determine an electrical delay associated with each of the two or more left ventricle electrodes, wherein the electrical delay is a measure of time delay between delivery of electrical stimulation to one of a cathode or anode of a stimulation vector and detecting the electrical stimulation at the other of the anode or cathode of the stimulation vector;

compare the electrical delay associated with each of the two or more left ventricle electrodes to an electrical delay threshold;

if the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, selecting a single left ventricle electrode for use during subsequent CRT therapy; and

if the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, selecting two or more of the left ventricle electrodes for use during subsequent CRT therapy.

18. The medical device system of claim 17, wherein:

if the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, the controller selects the left ventricle electrode with the longest associated delay for use during subsequent CRT therapy.

19. The medical device system of claim 17, wherein:

if the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, the controller selects two or more of the left ventricle electrodes that have associated electrical delays that are greater than the electrical delay threshold for use during subsequent CRT therapy.

20. The medical device system of claim 17, wherein:

if the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, the controller providing a pacing offset between pacing pulses of at least two of the two or more left ventricle electrodes during subsequent CRT therapy.