Local and non-local sensing for cardiac pacing

• US 8,527,048 B2
• Filed: 06/29/2006
• Issued: 09/03/2013
• Est. Priority Date: 06/29/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Sathaye, Alok S., McCabe, Aaron R., Yu, Yinghong
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): BEHRINGER, LUTHER G
• Application Number:
  US11/478,286
• Publication Number:
  US 20080009909A1
• Time in Patent Office: 2,623 Days
• Field of Search: 607/9
• US Class Current: 607/17
• CPC Class Codes: A61B 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• 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 1/36843 Bi-ventricular stimulation

Abstract

Systems and methods for determining pacing timing intervals based on the temporal relationship between the timing of local and non-local cardiac signal features are described. A device includes a plurality of implantable electrodes electrically coupled to the heart and configured to sense local and non-local cardiac signals. Sense circuitry coupled to first and second electrode pairs senses a local cardiac signal via a first electrode pair and a non-local cardiac signal via a second electrode pair. Detection circuitry is used to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber. A control processor times delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature.

Claims

1. A method for delivery of pacing therapy to a heart by a patient-internal medical device (PIMD) that includes a pulse generator disposed in a patient-implantable housing that may be provided with a header, the method comprising:

sensing, using body-implantable electrodes, at least one local cardiac electrical signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber and at least one non-local cardiac electrical signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the body-implantable electrodes including a non-local cardiac electrode pair that is used to sense the non-local cardiac electrical signal, the non-local cardiac electrode pair including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header;

sensing for a feature of the local signal corresponding to activation of the heart chamber;

sensing for a feature of the non-local signal corresponding to the activation of the heart chamber and including information about activation of a plurality of heart chambers; and

timing delivery of one or more pacing pulses based on a temporal relationship between timing of the feature of the local signal and timing of the feature of the non-local signal;

wherein the method is carried out on a beat-by-beat basis, such that the sensing for the feature of the local signal, the sensing for the feature of the non-local signal, and the timing delivery of a given one of the one or more pacing pulses are all associated with a given cardiac beat.

2. The method of claim 1, wherein sensing the at least one local cardiac electrical signal, sensing the at least one non-local cardiac electrical signal, and timing delivery of the one or more pacing pulses all occur during one cardiac cycle.

3. The method of claim 1, wherein timing delivery of the pacing pulses comprises determining an atrioventricular delay based on the temporal relationship between the local feature timing and the non-local feature timing.

4. The method of claim 1, wherein:

sensing the local cardiac signal comprises sensing from a local atrial site;

sensing for the local signal feature comprises sensing for a local P-wave;

sensing for the non-local signal feature comprises sensing for a non-local P-wave; and

timing the delivery of the pacing pulses comprises determining an atrioventricular delay based on the temporal relationship between the local P-wave and the non-local P-wave.

5. The method of claim 1, wherein:

sensing the local cardiac signal comprises sensing from a local atrial site;

sensing for the local signal feature comprises sensing for a local P-wave;

sensing for the non-local signal feature comprises sensing for a non-local P-wave; and

timing the delivery of the pacing pulses comprises;

initiating an atrioventricular delay based on the detection of the local P-wave; and

ending the atrioventricular delay based on the detection of the non-local P-wave.

6. A method for delivery of pacing therapy, comprising:

sensing, using body-implantable electrodes, at least one local cardiac electrical signal and at least one non-local cardiac electrical signal;

sensing for a feature of the local signal corresponding to activation of a heart chamber;

sensing for a feature of the non-local signal corresponding to activation of the heart chamber; and

timing delivery of one or more pacing pulses based on a temporal relationship between timing of the feature of the local signal and timing of the feature of the non-local signal;

wherein the body-implantable electrodes include a first electrode positioned in or on an implantable housing or header and a second electrode positioned in or on the implantable housing or header, the first and second electrodes being used for sensing for the feature of the non-local signal; and

wherein timing the delivery of the pacing pulses comprises;

triggering delivery of a pacing pulse based on the non-local feature if the non-local feature is detected; and

triggering delivery of the pacing pulse based on the local feature if the non-local feature is not detected.

7. The method of claim 6, wherein:

triggering delivery of the pacing pulse if the non-local feature is detected comprises triggering delivery of an atrial pacing pulse if a non-local P-wave is detected; and

triggering delivery of the pacing pulse comprises triggering delivery of the atrial pacing pulse based on a local P-wave.

8. The method of claim 6, wherein:

triggering delivery of the pacing pulse if the non-local feature is detected comprises triggering delivery of a ventricular pacing pulse if a non-local QRS complex is detected; and

triggering delivery of the pacing pulse based on the local feature comprises triggering delivery of the ventricular pacing pulse based on a local QRS complex if the non-local QRS complex is not detected.

9. An implantable cardiac rhythm management device, comprising:

a patient-internal medical device (PIMD) including a pulse generator disposed in a patient-implantable housing that may be provided with a header;

a plurality of implantable electrodes coupled to the housing and configured to electrically couple to a heart, at least a first pair of the plurality of electrodes configured to sense a local cardiac signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber and at least a second pair of the plurality of electrodes configured to sense a non-local cardiac signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the second pair of electrodes including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header;

sense circuitry coupled to the first and second electrode pairs and configured to sense the local cardiac signal via the first electrode pair and the non-local cardiac signal via the second electrode pair;

detection circuitry configured to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber; and

a control processor configured to time delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature;

wherein the device is configured to operate on a beat-by-beat basis, such that the control processor is configured to deliver a given one of the one or more pacing pulses during a same cardiac beat in which the sense circuitry senses the local cardiac signal and the non-local cardiac signal.

10. The device of claim 9, wherein:

the local signal feature comprises a local P-wave;

the non-local signal feature comprises a non-local P-wave; and

the control processor is configured determine an atrioventricular delay based on the temporal relationship between the timing of the local P-wave and the timing of the non-local P-wave, the atrioventricular delay used to time delivery of the one or more pacing pulses.

11. The device of claim 10, wherein the control processor is configured to determine the atrioventricular delay based on the temporal relationship between a beginning, end, or peak timing of the local P-wave and a beginning, end, or peak timing of the non-local P-wave.

12. The device of claim 9, wherein delivery of the pacing pulses comprises delivery of an atrioventricular synchronous pacing therapy.

13. The device of claim 9, wherein delivery of the pacing pulses comprises delivery of a bradycardia pacing therapy.

14. The device of claim 9, wherein the delivery of the pacing pulses comprises delivery of a resynchronization pacing therapy.

15. The device of claim 9, wherein:

the first pair of the plurality of electrodes is configured to sense the local cardiac signal from a local atrial site;

the detection circuitry configured to detect the local signal feature is configured to detect a local P-wave;

the detection circuitry configured to detect the non-local signal feature is configured to detect a non-local P-wave; and

the control processor configured to time delivery of the one or more pacing pulses is configured to initiate an atrioventricular delay based on the detection of the local P-wave, and to end the atrioventricular delay based on the detection of the non-local P-wave.

16. An implantable cardiac rhythm management device, comprising:

a plurality of implantable electrodes configured to electrically couple to a heart, the plurality of implantable electrodes including at least a first pair of electrodes and a second pair of electrodes;

sense circuitry coupled to the first and second electrode pairs and configured to sense a local cardiac signal via the first electrode pair and a non-local cardiac signal via the second electrode pair;

detection circuitry configured to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber; and

a control processor configured to time delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature;

wherein the control processor is configured to trigger pacing based on the timing of the non-local signal feature if the non-local signal feature is detected and to trigger pacing based on the timing of the local signal feature if the non-local signal feature is not detected.

17. The device of claim 16, wherein the non-local signal feature comprises a non-local P-wave, and the local signal feature comprises a local P-wave.

18. The device of claim 16, wherein the non-local signal feature comprises a non-local QRS complex, and the local signal feature comprises a local QRS complex.

19. A system for delivery of pacing therapy to a heart, comprising:

a patient-internal medical device (PIMD) including a pulse generator disposed in a patient-implantable housing that may be provided with a header;

a first pair of body-implantable electrodes coupled to the housing and configured to sense a local cardiac signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber;

a second pair of body-implantable electrodes coupled to the housing and configured to sense a non-local cardiac signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the second pair of electrodes including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header;

means for detecting a feature of the local signal related to activation of a cardiac chamber;

means for detecting a feature of the non-local signal related to activation of the cardiac chamber and including information about activation of a plurality of heart chambers; and

means for timing delivery of one or more pacing pulses based on a temporal relationship between timing of the local feature and timing of the non-local feature;

wherein the device is configured to operate on a beat-by-beat basis, such that the timing means is configured to deliver a given one of the one or more pacing pulses during a same cardiac beat in which the first and second pairs of body-implantable electrodes sense the local and non-local cardiac signals respectively.

20. The system of claim 19, further comprising means for determining an atrioventricular delay based on the temporal relationship.

21. The system of claim 19, further comprising means for implementing triggered pacing based on the temporal relationship between the timing of the local signal feature and the timing of the non-local signal feature.