Implantable cardiac resynchronizer with biventricular pacing and detection of loss of capture and anodal stimulation
First Claim
1. A method for an active implantable medical device that provides cardiac resynchronization by biventricular pacing, comprising:
- detecting atrial and ventricular events;
stimulating a right ventricle and a left ventricle by;
selectively operating the stimulation in at least one of a right only mode wherein only the right ventricle is stimulated or a left only mode wherein only the left ventricle is stimulated; and
selectively operating the stimulation in a biventricular mode wherein both ventricles are stimulated together;
using a sensor coupled to processing circuitry to provide an endocardial acceleration (EA) signal in each of the biventricular mode and the at least one of the right only mode or the left only mode;
extracting, from the EA signal, at least one predetermined EA parameter in each of the biventricular mode and the at least one of the right only mode or the left only mode;
using the EA parameters to evaluate the biventricular mode stimulation, the evaluation comprising comparing values of the EA parameter in the biventricular mode to the values of the EA parameter in at least one of the left only mode or the right only mode to distinguish between;
(a) normal operation, (b) a loss of a right ventricular capture or a left ventricular capture, and (c) possible anodal stimulation; and
conducting at least one update to operational parameters of the device based on the determined case.
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Abstract
A medical device for stimulating the heart using biventricular stimulation. The device includes a sensor for detecting an endocardial acceleration parameter and a processing circuit configured to receive the endocardial acceleration parameter. The device further includes stimulation electronics coupled to the processing circuit. The processing circuit is configured to use the EA parameter to evaluate the biventricular stimulation. The evaluation includes comparing the value of the EA parameter in biventricular mode to the value of the EA parameter in left only mode or right only mode, and using the comparison and an assessment of the variability of the EA parameter as a function of the AVD in the left or right mode to distinguish between cases comprising: (a) normal operation, (b) a loss of RV or LV capture, (c) possible anodal stimulation. The processing circuit is further configured to conduct at least one update to operational parameters of the device based on the determined case.
8 Citations
22 Claims
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1. A method for an active implantable medical device that provides cardiac resynchronization by biventricular pacing, comprising:
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detecting atrial and ventricular events; stimulating a right ventricle and a left ventricle by; selectively operating the stimulation in at least one of a right only mode wherein only the right ventricle is stimulated or a left only mode wherein only the left ventricle is stimulated; and selectively operating the stimulation in a biventricular mode wherein both ventricles are stimulated together; using a sensor coupled to processing circuitry to provide an endocardial acceleration (EA) signal in each of the biventricular mode and the at least one of the right only mode or the left only mode; extracting, from the EA signal, at least one predetermined EA parameter in each of the biventricular mode and the at least one of the right only mode or the left only mode; using the EA parameters to evaluate the biventricular mode stimulation, the evaluation comprising comparing values of the EA parameter in the biventricular mode to the values of the EA parameter in at least one of the left only mode or the right only mode to distinguish between;
(a) normal operation, (b) a loss of a right ventricular capture or a left ventricular capture, and (c) possible anodal stimulation; andconducting at least one update to operational parameters of the device based on the determined case. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13)
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14. An active implantable medical device that provides cardiac resynchronization by biventricular pacing, comprising:
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a first sensor configured to detect atrial and ventricular events; at least one electrode for stimulation of a right ventricle and a left ventricle; a second sensor configured to deliver an endocardial acceleration (EA) signal; a memory storing a plurality of executable instructions; and a processor configured to execute the instructions to; cause an atrioventricular delay (AVD) to be added to the stimulation, the AVD counted from a detection of a spontaneous or paced atrial event and at an end of which a right ventricular pacing is applied in an absence of detected spontaneous ventricular event; cause an interventricular delay (VVD) between the respective times of stimulation of the left and right ventricles; selectively operate in either a right only mode wherein only the right ventricle is paced, or a left only mode wherein only the left ventricle is stimulated, or in a biventricular mode wherein both ventricles are stimulated together; compare values of at least one predetermined EA parameter obtained respectively in the biventricular mode and in the left only mode; determine whether a difference between these values exceeds a first predetermined threshold; compare the values of the EA parameter obtained respectively in the biventricular mode and in the right only mode; determine if the difference between these values exceeds a second predetermined threshold; and determine in response to the first and second, third, fourth and fifth threshold comparisons, an occurrence of a possible loss of capture in the left or right ventricles, or a presence of a phenomenon of anodal stimulation. - View Dependent Claims (15, 16, 17, 18, 19, 20, 21)
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22. A medical device for stimulating a heart using a biventricular stimulation, comprising:
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a sensor that detects endocardial acceleration (EA) parameters; stimulation electronics coupled to a processor for the biventricular stimulation of a right ventricle and a left ventricle and for the stimulation of only the right ventricle or for the stimulation of only the left ventricle; a memory storing a plurality of executable instructions; and wherein the processor is configured to execute the instructions to; receive the endocardial acceleration parameters; use the EA parameters to evaluate the biventricular stimulation, the evaluation comprising; comparing a value of the EA parameter in biventricular mode to the value of the EA parameter in a right only mode wherein only the right ventricle is stimulated, or a left only mode wherein only the left ventricle is stimulated; and using the comparison to further compare to at least one threshold indicating an assessment of a variability of the EA parameter as a function of the AVD in the left or right mode to distinguish between cases comprising;
(a) normal operation, (b) a loss of right ventricle or left ventricle capture, (c) possible anodal stimulation; andconduct at least one update to operational parameters of the device based on the determined case.
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Specification