Systems, methods, and devices for adaptive cardiac therapy

Patent metadata

Field	Value
Publication number	US-11547858-B2
Application number	US-201916369948-A
Country	US
Kind code	B2
Filing date	Mar 29, 2019
Priority date	Mar 29, 2019
Publication date	Jan 10, 2023
Grant date	Jan 10, 2023

Abstract

Systems, methods, and devices are described herein for evaluation, adjustment, and delivery of adaptive cardiac therapy. The systems, methods, and devices may utilize electrical heterogeneity information to determine and/or select one or more pacing settings and pacing type or configurations for a plurality of different heart rates. The adaptive cardiac therapy may deliver cardiac therapy at selected pacing settings such as, for example, A-V and/or V-V intervals, according to a presently measured heart rate and switch between left ventricular-only or biventricular cardiac pacing therapy also according to the presently measured heart rate.

First claim

What is claimed:

1. An implantable medical device comprising:
a plurality of electrodes comprising an atrial pacing electrode, a left ventricle pacing electrode, and a right ventricle pacing electrode;
a therapy delivery circuit operably coupled to the plurality of electrodes to deliver cardiac therapy to the patient's heart;
a sensing circuit operably coupled to the plurality of electrodes to sense electrical activity of the patient's heart; and
a controller comprising processing circuitry operably coupled to the therapy delivery circuit and the sensing circuit, the controller configured to:
calibrate left ventricular-only pacing therapy for a plurality of heartrates based on electrical heterogeneity information (EHI) generated from monitored electrical activity from a plurality of external electrodes during left ventricular-only pacing therapy,
calibrate biventricular pacing therapy for a plurality of heartrates based on EHI generated from monitored electrical activity from a plurality of external electrodes during biventricular pacing therapy, and
deliver one of calibrated left ventricular-only pacing therapy and calibrated biventricular pacing therapy.

2. The implantable medical device of claim 1 , wherein the calibrated left ventricular-only pacing therapy comprises a determined A-V interval adjustment value for each different heart rate, wherein delivering calibrated left ventricular-only pacing therapy comprises:
monitoring heart rate;
measuring an intrinsic A-V delay during absence of delivery of pacing therapy; and
adjusting an A-V interval of the calibrated left ventricular-only pacing therapy using:
the determined A-V interval adjustment value corresponding to the monitored heart rate; and
the measured intrinsic A-V delay.

3. The implantable medical device of claim 2 , wherein the determined A-V interval adjustment value comprises one of a difference between the selected A-V interval and the measured intrinsic A-V delay and a percentage of the selected A-V interval to the measured intrinsic A-V delay.

4. The implantable medical device of claim 1 , wherein the calibrated biventricular pacing therapy comprises a determined A-V interval adjustment value for each different heart rate and a determined V-V interval adjustment value for each different heart rate, wherein delivering calibrated biventricular pacing therapy comprises:
monitoring heart rate;
measuring an intrinsic A-V delay during absence of delivery of pacing therapy;
adjusting an A-V interval of the calibrated left ventricular-only pacing therapy using:
the determined A-V interval adjustment value corresponding to the monitored heart rate; and
the measured intrinsic A-V delay; and

adjusting a V-V interval of the calibrated biventricular only pacing therapy using the determined V-V interval adjustment value corresponding to the monitored heart rate.

5. The implantable medical device of claim 1 , wherein the controller is further configured to:
monitor heart rate; and
switch from left ventricular-only pacing therapy to biventricular pacing therapy based on the monitored heart rate.

6. The implantable medical device of claim 1 , wherein the controller is further configured to:
measure an intrinsic A-V delay during absence of delivery of pacing therapy;
switch from left ventricular-only pacing therapy to biventricular pacing therapy based on the measured intrinsic A-V delay.

Assignees

• Medtronic Inc

Inventors

• Ghosh Subham
• Sambelashvili Aleksandre
• Gillberg Jeffrey
• Justen Manfred
• Farrell Sean

Classifications

• A61B5/29

  for permanent or long-term implantation · CPC title

• A61B5/346

  Analysis of electrocardiograms · CPC title

• A61N1/0484 Primary

  Garment electrodes worn by the patient · CPC title

• A61N1/37

  Monitoring; Protecting · CPC title

• A61B5/282

  Holders for multiple electrodes (for introduction into the body A61B5/287) · CPC title