Circuit-Based Devices and Methods for Pulse Control of Endocardial Pacing in Cardiac Rhythm Management

• US 20090005832A1
• Filed: 06/26/2008
• Published: 01/01/2009
• Est. Priority Date: 12/20/2004
• Status: Active Grant

• Current Assignee: Newstim, Inc.
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Zhu, Qingsheng, Ortega, Daniel Felipe
• Granted Patent: US 8,050,756 B2
• Time in Patent Office: Days
• US Class Current: 607/27
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

Tools and methods are particularly suited for certain cardiac conditions involving use of a catheter for pacing of the right and left ventricles from a lead in the right ventricle, e.g., to facilitate mechanically and/or electrically synchronous contractions for resynchronization. Certain aspects involve pacing and/or mapping by generating pulses for delivery to a cardiac site useful for improving heart function as measured, e.g., by QRS width, fractionation, late LV activation timing, mechanical synchronicity of free wall and septal wall, effective throughput/pressure, or a combination thereof. In one embodiment, an implantable pulse generator includes circuitry for generating pacing profiles, with signals of opposite polarities, specifically selected for delivery on electrodes at a site near the septal wall of a right ventricle of the heart.

Claims

1. For use in a myocardium capture by delivering pacing signals via electrodes to a target region in the right ventricle, near the septum of a heart and distal from an apex of the right ventricle, a circuit arrangement comprising:

leads, electrically coupled to the electrodes, for providing pacing signals of opposing polarity to the heart tissue; and

a tip and ring control module for generating pulse waveforms of opposing polarities to drive the leads with an electrical pacing signal that includes two pulses occurring sufficiently proximate one another for the myocardium capture near the target region.

2. The circuit arrangement of claim 1, wherein the two pulses occur sufficiently proximate one another for a single myocardium capture.

3. The circuit arrangement of claim 1, wherein the leads carry individually-controlled signals.

4. The circuit arrangement of claim 1, wherein the leads carry separately-controlled distinct signals.

5. The circuit arrangement of claim 1, wherein the leads are individually-addressable by the control module.

6. The circuit arrangement of claim 1, wherein the control module is an IPG and wherein the leads are individually-addressable by the IPG.

7. A method for treating an asynchronous condition of a heart of a patient using at least one electrode at a location in a right ventricle of the heart, the method comprising:

generating pulse waveforms of opposing polarities to drive said at least one electrode with an electrical pacing signal that includes two pulses occurring sufficiently proximate one another for the myocardium capture near the target region.

8. The method of claim 7, further including using the electrical pacing signal to pace the right ventricle and a left ventricle of the heart for synchronous contraction of the right and left ventricles using at least the first electrode at the location in the right ventricle.

9. The method of claim 7, further including using the electrical pacing signal to pace the right ventricle and a left ventricle of the heart for synchronous contraction of the right and left ventricles using at least the first electrode at the location in the right ventricle, and wherein the placement of said at least one electrode is defined by one of improving, relative to intrinsic activity, a QRS width of the patient, a fractionation of the patient and a timing of electrical stimulation of a late activation site of the left ventricle relative to the QRS.

10. The method of claim 7, further including determining a pacing location using a catheter arranged to provide pacing in a right ventricle of a heart and, the method comprising:

assessing a pacing location by delivering a pacing signal to a location in the right ventricle;

assessing the effectiveness of the delivered pacing signal as a function of at least one of a QRS width, fractionation and a timing of electrical stimulation of a late activation site of a left ventricle relative to the QRS;

adjusting the catheter to change the pacing location; and

repeating, for the changed pacing location, the steps of assessing the pacing location and assessing the effectiveness.

11. The method of claim 10, further including using the electrical pacing signal to pace the right ventricle and a left ventricle of the heart for synchronous contraction of the right and left ventricles using at least the first electrode at the location in the right ventricle, and wherein the placement of said at least one electrode is defined by one of improving, relative to intrinsic activity, a QRS width of the patient, a fractionation of the patient and a timing of electrical stimulation of a late activation site of the left ventricle relative to the QRS.