Delivery of bi-ventricular pacing therapy in a cardiac medical device and medical device system

• US 9,656,087 B2
• Filed: 10/22/2015
• Issued: 05/23/2017
• Est. Priority Date: 07/31/2015
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghosh, Subham
• Primary Examiner(s): GETZOW, SCOTT M
• Application Number:
  US14/919,912
• Publication Number:
  US 20170028203A1
• Time in Patent Office: 579 Days
• CPC Class Codes: A61B 5/283 Invasive
• CPC Class Codes: A61B 5/29 for permanent or long-term implantation
• CPC Class Codes: A61B 5/35 by template matching
• CPC Class Codes: A61B 5/352 Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
• CPC Class Codes: A61B 5/364 Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61N 1/056 Transvascular endocardial electrode systems
• 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 1/3682 with a variable atrioventricular delay
• 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
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD
• CPC Class Codes: A61N 1/371 Capture, i.e. successful stimulation
• CPC Class Codes: A61N 1/3712 Auto-capture, i.e. automatic adjustment of the stimulation threshold
• CPC Class Codes: A61N 1/37223 Circuits for electromagnetic coupling
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/3956 Implantable devices for applying electric shocks to the heart, e.g. for cardioversion

Abstract

An implantable medical device and medical device system for delivering a bi-ventricular pacing therapy that includes a plurality of electrodes to sense a cardiac signal, an emitting device to emit a trigger signal to control delivery of the bi-ventricular pacing, and a processor configured to compare the sensed cardiac signal associated with the delivered bi-ventricular pacing to at least one of an intrinsic beat template and an RV template associated with a morphology of RV-only pacing therapy, determine whether an offset interval associated with the bi-ventricular pacing therapy is set to a maximum offset interval level in response to the comparing, adjust the offset interval in response to the offset interval not being set to the maximum offset interval level, and generate the trigger signal to be emitted by the emitting device to subsequently deliver the bi-ventricular pacing therapy having the adjusted offset interval.

Claims

1. A medical device system for delivering a bi-ventricular pacing therapy, comprising:

a leadless pacing device capable of being positioned within a left ventricle of a patient'"'"'s heart and comprising electrodes to deliver the bi-ventricular pacing therapy;

an implantable medical device comprising a plurality of electrodes and capable of being positioned within a right ventricle of the heart to deliver the bi-ventricular pacing therapy and to sense a cardiac signal;

an emitting device to emit a trigger signal to control delivery of the bi-ventricular pacing therapy; and

a processor configured to compare the sensed cardiac signal associated with the delivered bi-ventricular pacing to at least one of an intrinsic beat template and an RV template associated with a morphology of RV-only pacing therapy, determine whether an offset interval associated with the bi-ventricular pacing therapy is set to a maximum offset interval level in response to the comparing, adjust the offset interval in response to the offset interval not being set to the maximum offset interval level, and generate the trigger signal to be emitted by the emitting device to subsequently deliver the bi-ventricular pacing therapy having the adjusted offset interval.

2. The medical device system of claim 1, wherein the processor is configured to determine whether the offset interval associated with the bi-ventricular pacing therapy is set to the maximum offset interval level in response to both the cardiac signal not matching the intrinsic beat template and the cardiac signal matching the RV template.

3. The medical device system of claim 1, wherein the processor is configured to determine, in response to the cardiac signal matching the intrinsic beat template, whether an atrioventricular delay associated with the delivered bi-ventricular pacing therapy is greater than a delay threshold, and adjust the atrioventricular delay in response to the atrioventricular delay being greater than the delay threshold.

4. The medical device system of claim 1, wherein the processor is configured to determine, in response to both the sensed cardiac signal not matching the intrinsic beat template and the cardiac signal not matching the RV template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a minimum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the minimum pacing rate threshold.

5. The medical device system of claim 1, wherein the processor is configured to determine, in response to the cardiac signal matching the intrinsic beat template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a maximum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the maximum pacing rate threshold.

6. The medical device system of claim 1, wherein the processor is configured to determine whether the medical device system is in one of a VDD/DDD pacing mode and a VVI pacing mode, if in a VDD/DDD pacing mode, determine, in response to the cardiac signal matching the intrinsic beat template, whether an atrioventricular delay associated with the delivered bi-ventricular pacing therapy is greater than a delay threshold, and adjust the atrioventricular delay in response to the atrioventricular delay being greater than the delay threshold, and if in a VVI pacing mode, and if in the VVI pacing mode, determine, in response to both the sensed cardiac signal not matching the intrinsic beat template and the cardiac signal not matching the RV template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a minimum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the minimum pacing rate threshold.

7. The medical device system of claim 6, wherein the processor is configured to determine, if in the VVI pacing mode, and in response to the cardiac signal matching the intrinsic beat template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a maximum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the maximum pacing rate threshold.

8. The medical device system of claim 7, wherein the processor is configured to determine whether the offset interval associated with the bi-ventricular pacing therapy is set to a maximum offset interval level in response to both the cardiac signal not matching the intrinsic beat template and the cardiac signal matching the RV template.

9. The medical device system of claim 8, wherein the processor is configured to determine whether to adjust pacing outputs associated with the delivered bi-ventricular pacing therapy in response to the offset interval being set to the maximum offset interval level.

10. A medical device system for delivering a bi-ventricular pacing therapy, comprising:

a leadless pacing device capable of being positioned within a left ventricle of a patient'"'"'s heart and comprising electrodes to deliver the bi-ventricular pacing therapy;

a leadless pacing device capable of being positioned within a right ventricle of a patient'"'"'s heart and comprising electrodes to deliver the bi-ventricular pacing therapy;

a subcutaneously implantable device comprising a subcutaneous electrode to sense a cardiac signal;

an emitting device to emit a trigger signal to control delivery of the bi-ventricular pacing therapy; and

a processor configured to compare the sensed cardiac signal associated with the delivered bi-ventricular pacing to at least one of an intrinsic beat template and an RV template associated with a morphology of RV-only pacing therapy, determine whether an offset interval associated with the bi-ventricular pacing therapy is set to a maximum offset interval level in response to the comparing, adjust the offset interval in response to the offset interval not being set to the maximum offset interval level, and generate the trigger signal to be emitted by the emitting device to subsequently deliver the bi-ventricular pacing therapy having the adjusted offset interval.

11. The medical device system of claim 10, wherein the processor is configured to determine whether the offset interval associated with the bi-ventricular pacing therapy is set to the maximum offset interval level in response to both the cardiac signal not matching the intrinsic beat template and the cardiac signal matching the RV template.

12. The medical device system of claim 10, wherein the processor is configured to determine, in response to the cardiac signal matching the intrinsic beat template, whether an atrioventricular delay associated with the delivered bi-ventricular pacing therapy is greater than a delay threshold, and adjust the atrioventricular delay in response to the atrioventricular delay being greater than the delay threshold.

13. The medical device system of claim 10, wherein the processor is configured to determine, in response to both the sensed cardiac signal not matching the intrinsic beat template and the cardiac signal not matching the RV template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a minimum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the minimum pacing rate threshold.

14. The medical device system of claim 10, wherein the processor is configured to determine, in response to the cardiac signal matching the intrinsic beat template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a maximum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the maximum pacing rate threshold.

15. The medical device system of claim 10, wherein the processor is configured to determine whether the medical device system is in one of a VDD/DDD pacing mode and a VVI pacing mode, if in a VDD/DDD pacing mode, determine, in response to the cardiac signal matching the intrinsic beat template, whether an atrioventricular delay associated with the delivered bi-ventricular pacing therapy is greater than a delay threshold, and adjust the atrioventricular delay in response to the atrioventricular delay being greater than the delay threshold, and if in a VVI pacing mode, and if in the VVI pacing mode, determine, in response to both the sensed cardiac signal not matching the intrinsic beat template and the cardiac signal not matching the RV template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a minimum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the minimum pacing rate threshold.

16. The medical device system of claim 15, wherein the processor is configured to determine, if in the VVI pacing mode, and in response to the cardiac signal matching the intrinsic beat template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a maximum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the maximum pacing rate threshold.

17. The medical device system of claim 16, wherein the processor is configured to determine whether the offset interval associated with the bi-ventricular pacing therapy is set to a maximum offset interval level in response to both the cardiac signal not matching the intrinsic beat template and the cardiac signal matching the RV template.

18. The medical device system of claim 17, wherein the processor is configured to determine whether to adjust pacing outputs associated with the delivered bi-ventricular pacing therapy in response to the offset interval being set to the maximum offset interval level.

19. An implantable medical device for delivering a bi-ventricular pacing therapy, comprising:

a plurality of electrodes to sense a cardiac signal;

an emitting device to emit a trigger signal to control delivery of the bi-ventricular pacing; and

a processor configured to compare the sensed cardiac signal associated with the delivered bi-ventricular pacing to at least one of an intrinsic beat template and an RV template associated with a morphology of RV-only pacing therapy, determine whether an offset interval associated with the bi-ventricular pacing therapy is set to a maximum offset interval level in response to the comparing, adjust the offset interval in response to the offset interval not being set to the maximum offset interval level, and generate the trigger signal to be emitted by the emitting device to subsequently deliver the bi-ventricular pacing therapy having the adjusted offset interval.

20. The medical device system of claim 19, wherein the processor is configured to determine whether the offset interval associated with the bi-ventricular pacing therapy is set to the maximum offset interval level in response to both the cardiac signal not matching the intrinsic beat template and the cardiac signal matching the RV template.

21. The medical device system of claim 19, wherein the processor is configured to determine, in response to the cardiac signal matching the intrinsic beat template, whether an atrioventricular delay associated with the delivered bi-ventricular pacing therapy is greater than a delay threshold, and adjust the atrioventricular delay in response to the atrioventricular delay being greater than the delay threshold.

22. The medical device system of claim 19, wherein the processor is configured to determine, in response to both the sensed cardiac signal not matching the intrinsic beat template and the cardiac signal not matching the RV template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a minimum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the minimum pacing rate threshold.

23. The medical device system of claim 19, wherein the processor is configured to determine, in response to the cardiac signal matching the intrinsic beat template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a maximum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the maximum pacing rate threshold.

24. The medical device system of claim 19, wherein the processor is configured to determine whether the medical device system is in one of a VDD/DDD pacing mode and a VVI pacing mode, if in a VDD/DDD pacing mode, determine, in response to the cardiac signal matching the intrinsic beat template, whether an atrioventricular delay associated with the delivered bi-ventricular pacing therapy is greater than a delay threshold, and adjust the atrioventricular delay in response to the atrioventricular delay being greater than the delay threshold, and if in a VVI pacing mode, and if in the VVI pacing mode, determine, in response to both the sensed cardiac signal not matching the intrinsic beat template and the cardiac signal not matching the RV template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a minimum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the minimum pacing rate threshold.

25. The medical device system of claim 24, wherein the processor is configured to determine, if in the VVI pacing mode, and in response to the cardiac signal matching the intrinsic beat template, whether a pacing rate associated with the delivered bi-ventricular pacing therapy is greater than a maximum pacing rate threshold, and adjust the pacing rate in response to the pacing rate associated with the delivered bi-ventricular pacing therapy being greater than the maximum pacing rate threshold.

26. The medical device system of claim 25, wherein the processor is configured to determine whether the offset interval associated with the bi-ventricular pacing therapy is set to a maximum offset interval level in response to both the cardiac signal not matching the intrinsic beat template and the cardiac signal matching the RV template.

27. The medical device system of claim 26, wherein the processor is configured to determine whether to adjust pacing outputs associated with the delivered bi-ventricular pacing therapy in response to the offset interval being set to the maximum offset interval level.