Bi-ventricular ventricular capture management in cardiac resyncronization therapy delivery devices

Abstract

The present invention provides a technique for verifying pacing capture of a ventricular chamber, particularly to ensure desired delivery of a ventricular pacing regime (e.g., “CRT”). The invention also provides ventricular capture management by delivering a single ventricular pacing stimulus and checking inter-ventricular conduction during a temporal window to determine if the stimulus captured. If a loss-of-capture (LOC) signal results from the capture management testing, then the applied pacing pulses are modified and the conduction test repeated. If LOC, an alert message can issue. Other aspects include: use of a trend of A-RV/LV and LV-RV timing intervals to monitor changes in the patient's heart conduction properties; bi-ventricular verification test and search—while still pacing BiV by detecting latent sense; single-V pacing threshold search, use of timing of sense in other V chamber to establish capture and LOC windows; (iv) use of a premature V pace rather than short AV interval if VV cannot be discriminated from AV; (v) option to run a threshold search only if the Bi-ventricular verification test fails.

Description

CROSS REFERENCE TO RELATED APPLICATIONS [0001] This non-provisional U.S. patent application claims the benefit of prior U.S. provisional patent application Ser. No. 60 / 637,633 of common title, filed 20 Dec. 2004 and also relates to a co-pending provisional U.S. patent application by Sheth et al.; namely Ser. No. 60 / 637,620 (Atty. Dkt. P-10798.00) filed 20 Dec. 2004, and entitled, “AUTOMATIC LV / RV CAPTURE VERIFICATION AND DIAGNOSTICS;” a co-pending provisional U.S. patent application by Sheldon et al.; namely Ser. No. 60 / 637,571 (Atty. Dkt. P-20777.00) filed 20 Dec. 2004, and entitled, “METHOD OF CONTINUOUS CAPTURE VERIFICATIONS IN CARDIAC RESYNCHRONIZATION DEVICES,” and a co-pending provisional U.S. patent application by Kleckner et al., namely Ser. No. 60 / 637,532 (Atty. Dkt. No. P-21289.00) filed 20 Dec. 2004 and entitled “LV THRESHOLD MEASUREMENT AND CAPTURE MANAGEMENT,” the entire contents of each, including all exhibits thereof, are hereby incorporated by reference herein.FIELD ...

AI Technical Summary

Benefits of technology

[0014] Among other contributions to the art, the present invention addresses the issues identified above of not providing adequate metrics (or diagnostics) to a physician regarding LV (and therefore bi-ventricular) capture. The invention addresses this significant need where capture management functionality is not available in a CRT device. According to the invention, the bi-ventricular capture management as described here measures and monitors pacing thresholds at each of pacing sites being used in CRT delivery while the patient is ambulatory. The ability to obtain the LV and RV thresholds and modulate these outputs helps assure greater likelihood of bi-ventricular capture. Such dual site capture is critical in order for a patient to benefit from CRT. Bi-ventricular capture verification and capture management is also an important e...

Problems solved by technology

However, due to a number of factors for a variety of patients such cardiac pacing systems may not always effectively delivery CRT.

Left ventricular capture in particular is a clinical issue with present-generation (and foreseeable) CRT systems, due to acknowledged difficulty of maintaining stable lead situation in the cardiac venous anatomy.

Since CRT delivery becomes ineffective (possibly even deleterious) if LV capture is lost, diagnosis of dislodgment and maintenance of capture are high priorities.

Presently, the only somewhat similar diagnostic available in CRT devices is percent-ventricular pacing (%Vpacing), which ind...

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