System and method for cardiac pacing

• US 9,731,138 B1
• Filed: 04/28/2016
• Issued: 08/15/2017
• Est. Priority Date: 02/17/2016
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Audet, Sarah A, Stadler, Robert W, Yang, Zhongping, Carney, James K, Reinke, James D, Wahlstrand, John D, Ries, Andrew J
• Primary Examiner(s): Kahelin, Michael
• Application Number:
  US15/141,430
• Publication Number:
  US 20170232261A1
• Time in Patent Office: 474 Days
• CPC Class Codes: A61B 5/287 Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
• CPC Class Codes: A61N 1/057 Anchoring means; Means for fixing the head inside the heart
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/37288 Communication to several implantable medical devices within one patient
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators
• CPC Class Codes: A61N 1/3787 from an external energy source

Abstract

An implantable medical device system is configured to deliver cardiac pacing by receiving a cardiac electrical signal by sensing circuitry of a first device via a plurality of sensing electrodes, identifying by a control module of the first device a first cardiac event from the cardiac electrical signal, setting a first pacing interval in response to identifying the first cardiac event, controlling a power transmitter of the first device to transmit power upon expiration of the first pacing interval, receiving the transmitted power by a power receiver of a second device; and delivering at least a portion of the received power to a patient'"'"'s heart via a first pacing electrode pair of the second device coupled to the power receiver.

Claims

1. An implantable medical device system for delivering cardiac pacing, comprising:

a first device comprising a power transmitter, sensing circuitry, a control module, a first housing enclosing the power transmitter, the sensing circuitry and the control module, a plurality of sensing electrodes, and an extra-cardiovascular sensing extension extending from the first housing and carrying at least one of the plurality of sensing electrodes, the control module configured to;

identify a first cardiac event by identifying a P-wave from a cardiac electrical signal received by the sensing circuitry via the plurality of sensing electrodes,

identify a second cardiac event by identifying an R-wave;

determine an interval between the P-wave and the R-wave; and

set a first pacing interval to be less than the interval between the P-wave and the R-wave in response to identifying the first cardiac event, and

control the power transmitter to transmit power upon expiration of the first pacing interval; and

a second device comprising a pacing electrode pair, a second housing, and a power receiver enclosed by the second housing, the power receiver coupled to the first pacing electrode pair, the first pacing electrode pair carried by the second housing;

wherein the power receiver is configured to receive the transmitted power and deliver at least a portion of the received power to a patient'"'"'s heart via the first pacing electrode pair.

2. The system of claim 1, wherein the extension comprises a proximal end coupled to the first housing, a distal end extending away from the first housing, and a body extending from the proximal end to the distal end, the body having at least one bend, at least one of the plurality of sensing electrodes carried by the body distal to the at least one bend.

3. The system of claim 2, wherein the extension comprises a second electrode of the plurality of sensing electrodes carried by the body proximal to the at least one bend.

4. The system of claim 1, wherein the first device comprises a third electrode of the plurality of electrodes carried by one of the first housing and the sensing extension body, wherein the first electrode and the third electrode define a first sensing vector and the second electrode and one of the first electrode and the third electrode define a second sensing vector different than the first sensing vector.

5. The system of claim 1, wherein the extra-cardiovascular sensing extension comprises a proximal end coupled to the first housing, a distal end extending away from the first housing, and a body extending from the proximal end to the distal end, the body comprising a curved portion between the proximal end and the distal end, a first sensing electrode of the plurality of sensing electrodes carried along the curved portion, a second sensing electrode of the plurality of sensing electrodes carried proximal to the curved portion, and a third sensing electrode of the plurality of sensing electrodes carried distal to the curved portion, the first, second and third sensing electrodes defining at least two different sensing electrode vectors.

6. The system of claim 1, wherein at least a portion of the extra-cardiovascular sensing extension is configured to be deployed along an intercostal space of the patient.

7. The system of claim 1, wherein at least a portion of the extra-cardiovascular sensing extension is configured to be deployed substernally.

8. The system of claim 1, wherein:

the second device further comprises an activity sensor; and

the control module is configured to;

determine a second pacing interval based on a signal from the activity sensor;

start the second pacing interval upon identifying an R-wave; and

control the power transmitter to transmit power in response to expiration of the second pacing interval.

9. The system of claim 8, wherein the control module is further configured to:

determine whether identifying of the first cardiac event is unavailable;

disable setting the first pacing interval in response to determining that identifying the first cardiac event is unavailable; and

enable setting the second pacing interval in response to disabling setting the first pacing interval.

10. The system of claim 9, wherein the control module is configured to:

identify a next first cardiac event during the second pacing interval;

re-enable setting the first pacing interval in response to identifying the next first cardiac event; and

disable setting the second pacing interval in response to re-enabling setting the first pacing interval.

11. The system of claim 1, wherein the power transmitter comprises a first coil for inductive power transmission and the power receiver includes a second coil for receiving the transmitted power.

12. The system of claim 1, wherein the power transmitter comprises a transmitting ultrasound transducer for transmitting the power and the power receiver includes a receiving ultrasound transducer for receiving the transmitted power.

13. The system of claim 1, wherein the second device is deployed to deliver at least a portion of the transmitted power to evoke a depolarization of the left ventricle.

14. The system of claim 1, further including a third device comprising a second pacing electrode pair, a third housing, and a second power receiver enclosed by the third housing, the second power receiver coupled to the second pacing electrode pair, the second pacing electrode pair carried by the third housing;

wherein the third device is configured to receive power transmitted by the second device and deliver at least a second portion of the transmitted power to the patient'"'"'s heart via the second electrode pair.

15. The system of claim 14, wherein:

the second device is configured to be deployed for delivering the portion of the transmitted power via the first pacing electrode pair to a first location of the patient'"'"'s heart;

the third device is configured to be deployed for delivering the second portion of the transmitted power via the second pacing electrode pair to a second location of the patient'"'"'s heart spaced apart from the first location.

16. The system of claim 15, wherein the first location is along a left ventricle of the heart and the second location is along a right ventricle of the patient heart.

17. A method for delivering cardiac pacing by an implantable medical device system, comprising:

receiving a cardiac electrical signal via a plurality of sensing electrodes coupled to sensing circuitry of a first device, at least one of the plurality of sensing electrodes carried by an extra-cardiovascular sensing extension extending from the first device;

identifying by a control module of the first device a first cardiac event by identifying a P-wave from the cardiac electrical signal;

identifying a second cardiac event by identifying an R-wave;

determining an interval between the P-wave and the R-wave;

setting a first pacing interval to be less than the interval between the P-wave and the R-wave in response to identifying the first cardiac event;

controlling a power transmitter of the first device to transmit power upon expiration of the first pacing interval;

receiving the transmitted power by a power receiver of a second device; and

delivering at least a portion of the received power to a patient'"'"'s heart via a first pacing electrode pair of the second device coupled to the power receiver.

18. The method of claim 17, wherein receiving the cardiac electrical signal comprises receiving the signal using one of the plurality of sensing electrodes carried distal to a bend of a body of the sensing extension, the body extending from a proximal end coupled to a housing of the first device to a distal end extending away from the housing.

19. The method of claim 18, wherein receiving the cardiac electrical signal comprises receiving the signal using a second electrode of the plurality of sensing electrodes carried by the body proximal to the bend.

20. The method of claim 17, wherein receiving the cardiac electrical signal comprises selecting one of a first sensing electrode vector and a second sensing electrode vector for receiving the cardiac electrical signal,

wherein the first sensing electrode vector is defined by a first electrode carried by the sensing extension body and a second electrode carried by a housing of the first device,

the second sensing electrode vector is defined by a third electrode carried by the sensing extension body and one of the first electrode and the third electrode.

21. The method of claim 17, wherein receiving the cardiac electrical signal comprises selecting one of a first sensing electrode vector and a second sensing electrode vector for receiving the cardiac electrical signal,

wherein the first sensing electrode vector comprises a first electrode carried by a curving portion of a body of the sensing extension and a second electrode carried proximal to the curving portion of the sensing extension body;

the second sensing electrode vector comprises one of the first electrode and the second electrode and a third electrode carried distal to the curving portion of the sensing extension body.

22. The method of claim 17, further comprising deploying the extra-cardiovascular sensing extension along an intercostal space of the patient for receiving the cardiac electrical signal.

23. The method of claim 17, further comprising deploying at least a portion of the extra-cardiovascular sensing extension substernally.

24. The method of claim 17, further comprising:

determining a second pacing interval based on a signal from an activity sensor;

starting the second pacing interval upon identifying an R-wave; and

controlling the power transmitter to transmit power in response to expiration of the second pacing interval.

25. The method of claim 24, further comprising:

determining whether identifying of the first cardiac event is unavailable;

disabling setting the first pacing interval in response to determining that identifying the first cardiac event is unavailable; and

enabling setting the second pacing interval in response to disabling setting the first pacing interval.

26. The method of claim 25, further comprising:

identifying a next first cardiac event during the second pacing interval;

re-enabling setting the first pacing interval in response to identifying the next first cardiac event; and

disabling setting the second pacing interval in response to re-enabling setting the first pacing interval.

27. The method of claim 17, wherein transmitting the power comprises applying current to a first coil for inductive power transmission and receiving the transmitted power comprises harvesting current induced in a second coil by the current applied to the first coil.

28. The method of claim 17, wherein transmitting the power comprises activating an ultrasound transducer and receiving the power comprises harvesting power includes harvesting current induced in a receiving ultrasound transducer.

29. The method of claim 17, wherein delivering at least a portion of the received power to a patient'"'"'s heart via the first pacing electrode pair comprises delivering at least a portion of the transmitted power to evoke a depolarization of the left ventricle.

30. The method of claim 17, further comprising:

receiving at least a portion of the transmitted power by a third device having a second pacing electrode pair; and

delivering at least a second portion of the transmitted power to the patient'"'"'s heart via the second electrode pair.

31. The method of claim 30, further comprising:

deploying the second device having the first pacing electrode pair to a first location of the patient'"'"'s heart; and

deploying the third device having the second pacing electrode pair to a second location of the patient'"'"'s heart spaced apart from the first location.

32. The method of claim 31, wherein:

deploying the second device to the first location comprises deploying the second device along a left ventricle of the patient'"'"'s heart; and

deploying the third device to the second location comprises deploying the third device along a right ventricle of the patient'"'"'s heart.

33. A non-transitory, computer-readable medium comprising a set of instructions which when executed by a control module of an implantable medical device system comprising a first device and a second device cause the system to:

receive a cardiac electrical signal via a plurality of sensing electrodes coupled to sensing circuitry of the first device, at least one of the plurality of sensing electrodes carried by an extra-cardiovascular sensing extension extending from the first device;

identify by a control module of the first device a first cardiac event by identifying a P-wave from the cardiac electrical signal;

identifying a second cardiac event by identifying an R-wave;

determining an interval between the P-wave and the R-wave;

setting a first pacing interval to be less than the interval between the P-wave and the R-wave in response to identifying the first cardiac event;

control a power transmitter of the first device to transmit power upon expiration of the first pacing interval;

receive the transmitted power by a power receiver of the second device; and

deliver at least a portion of the received power to a patient'"'"'s heart via a pacing electrode pair of the second device coupled to the power receiver.

34. An implantable medical device comprising:

a power transmitter,

sensing circuitry,

a control module,

a housing enclosing the power transmitter, the sensing circuitry and the control module,

a plurality of sensing electrodes, and

an extra-cardiovascular sensing extension extending from the housing and carrying at least one of the plurality of sensing electrodes, the control module configured to;

identify a first cardiac event by identifying a P-wave from a cardiac electrical signal received by the sensing circuitry via the plurality of sensing electrodes,

identify a second cardiac event by identifying an R-wave;

determine an interval between the P-wave and the R-wave; and

set a first pacing interval to be less than the interval between the P-wave and the R-wave in response to identifying the first cardiac event, and

control the power transmitter to transmit power for pacing to another device upon expiration of the first pacing interval.

35. The system of claim 34, wherein the extension comprises a proximal end coupled to the first housing, a distal end extending away from the first housing, and a body extending from the proximal end to the distal end, the body having at least one bend, at least one of the plurality of sensing electrodes carried by the body distal to the at least one bend.

36. The system of claim 35, wherein the extension comprises a second electrode of the plurality of sensing electrodes carried by the body proximal to the at least one bend.

37. The system of claim 34, wherein the first device comprises a third electrode of the plurality of electrodes carried by one of the first housing and the sensing extension body, wherein the first electrode and the third electrode define a first sensing vector and the second electrode and one of the first electrode and the third electrode define a second sensing vector different than the first sensing vector.

38. The system of claim 34, wherein the extra-cardiovascular sensing extension comprises a proximal end coupled to the first housing, a distal end extending away from the first housing, and a body extending from the proximal end to the distal end, the body comprising a curved portion between the proximal end and the distal end, a first sensing electrode of the plurality of sensing electrodes carried along the curved portion, a second sensing electrode of the plurality of sensing electrodes carried proximal to the curved portion, and a third sensing electrode of the plurality of sensing electrodes carried distal to the curved portion, the first, second and third sensing electrodes defining at least two different sensing electrode vectors.

39. The system of claim 34, wherein the power transmitter comprises a first coil for inductive power transmission.

40. The system of claim 34, wherein the power transmitter comprises a transmitting ultrasound transducer for transmitting the power.