Systems and methods for managing atrial-ventricular delay adjustments

Patent metadata

Field	Value
Publication number	US-11654288-B2
Application number	US-202016988821-A
Country	US
Kind code	B2
Filing date	Aug 10, 2020
Priority date	Aug 10, 2020
Publication date	May 23, 2023
Grant date	May 23, 2023

Abstract

A system and method are provided for managing atrial-ventricular (AV) delay adjustments. An AV interval is measured that corresponds to an interval between an atrial paced (Ap) event or an atrial sensed (As) event and a sensed ventricular (Vs) event. A candidate AV delay is set based on the AV interval and a bundle branch adjustment (BBA) value. A QRS characteristic of interest (COI) is measured while utilizing the candidate AV delay in connection with delivering a pacing therapy. The BBA value is adjusted and the candidate AV delay is reset based on the BBA value as adjusted. A collection of QRS COIs and corresponding candidate AV delays are obtained and one of the candidate AV delays is selected as a BBA AV delay. The pacing therapy is managed, based on the BBA AV delay.

First claim

What is claimed is:

1. A system for managing atrial-ventricular (AV) delay adjustments, the system comprising:
an implantable medical device (IMD) having a header that includes a right atrial (RA) header port, a right ventricular (RV) header port and a left ventricular (LV) header port;
a first lead having a first electrode configured to be located proximate to an atrial (A) site, the first lead having a proximal end with a first lead terminal connected to the RA header port; and
a second lead having a second electrode configured to be located proximate to at least one of a left bundle branch (LBB) site or a HIS bundle, the second lead having a proximal end with a second lead terminal connected to the RV or LV header port,
memory configured to store program instructions;
one or more processors that, when configured to execute the program instructions:
measure an AV interval corresponding to an interval between Lan atrial paced (Ap) event or an atrial sensed (As) event, paced or sensed at the first electrode, and La sensed ventricular (Vs) event sensed at the second electrode;
set a candidate AV delay based on the AV interval and based on a bundle branch adjustment (BBA) value, wherein the BBA value represents an adjustment to the AV interval to account for sensing the Vs event at the second electrode which is located proximate to at least one of the LBB site or the HIS bundle but connected to the RV or LV header port;
measure a QRS characteristic of interest (COI) while utilizing the candidate AV delay in connection with delivering a pacing therapy by the IMD;
adjust the BBA value and reset the candidate AV delay based on the AV interval and the BBA value as adjusted;
repeat the adjust, reset and measure to obtain a collection of QRS COIs and corresponding candidate AV delays;
select one of the candidate AV delays, that corresponds to a select one of the QRS COIs, as a BBA AV delay; and
manage the pacing therapy, utilized by the IMD, based on the BBA AV delay.

2. The system of claim 1 , wherein the one or more processors are configured, when executing the program instructions, to implement, as the pacing therapy, a DDD mode pacing therapy, wherein the second electrode represents an LBB electrode configured to be implanted through a septal wall to a depth sufficient to be located proximate to the LBB site, the second lead terminal configured to connect the LBB electrode to the RV header port; and
the IMD further comprising sensing circuitry configured to sense cardiac activity (CA) signals over an RV sensing channel, associated with the RV header port, wherein the CA signals are collected along a sensing vector defined at least in part by the LBB electrode,
wherein the measure, adjust, repeat and select operations are based in part on the CA signals.

3. The system of claim 1 , wherein the one or more processors are further configured to select the one of the candidate AV delays that manages delivery of pacing pulses at the LBB site at a select point in time before an intrinsic wave front is expected to propagate to or beyond a corresponding point along a right bundle branch.

4. The system of claim 1 , wherein the one or more processors are further configured to select the one of the candidate AV delays that resulted in a narrowest QRS duration within the collection of QRS COIs.

5. The system of claim 1 , wherein the one or more processors are further configured to repeatedly adjust the candidate AV delay by subtracting, from the AV interval, multiple candidate BBA values in order to time delivery of pacing pulses at the LBB site at a point in time fused with intrinsic waveform propagation to or beyond a corresponding point along a right bundle branch.

6. The system of claim 1 , wherein the second electrode represents an LBB electrode configured to be implanted through a septal wall to a depth sufficient to be located proximate to the LBB site, the second lead terminal configured to connect the LBB electrode to the LV header port, wherein the pacing therapy corresponds to a cardiac resynchronization therapy (CRT) pacing therapy configured to deliver pacing pulses through the LV header port of the IMD to the LBB electrode.

7. The system of claim 6 , wherein the one or more processors are further configured to select the one of the candidate AV delays that manages delivery of pacing pulses at the LBB site at a select point in time after an intrinsic wave front is expected to propagate to or beyond a corresponding point along a right bundle branch.

8. The system of claim 1 ,
wherein the second electrode represents a load including a HIS electrode configured to be located at the HIS bundle, the lead including a proximal terminal configured to connect the HIS electrode to the RV header port; the IMD further comprising:
sensing circuit configured to sense cardiac activity (CA) signals over an RV sensing channel associated with the RV header port, wherein the CA signals are collected along a sensing vector defined at least in part by the HIS electrode, the candidate AV delays and BBA AV delays following a new As or Ap event before a pacing stimulus is delivered through the RV header port to the HIS bundle.

9. The system of claim 1 , wherein the BBA value provides an adjustment to the AV interval to account for the Vs event being sensed at the second electrode when connected to the RV header port and located proximate to at least one of the LBB site or the HIS bundle.

10. The system of claim 1 , wherein the BBA value provides an adjustment to the AV interval to account for the Vs event being sensed at the second electrode when configured to be located proximate to the LBB site and the second lead terminal is connected to the RV header port.

11. The system of claim 1 , wherein the second electrode is configured to be located proximate to the HIS bundle and the second lead terminal is connected to the RV header port, the system further comprising a third lead having a third electrode configured to be located proximate to the LV and having a third lead terminal connected to the LV header port.

12. The system of claim 1 , wherein the second electrode is configured to be located proximate to the HIS bundle and the second lead terminal is connected to the LV header port, the system further comprising a third lead having a third electrode configured to be located proximate to a right ventricular (RV) apex and having a third lead terminal connected to the RV header port.

13. A system for managing atrial-ventricular (AV) delay adjustments, the system comprising:
electrodes configured to be located proximate to an atrial (A) site and at least one of a left bundle branch (LBB) site or a HIS bundle;
an implantable medical device (IMD) having a header that includes a right atrial (RA) header port, a right ventricular (RV) header port and a left ventricular (LV) header port;
memory configured to store program instructions;
one or more processors that, when configured to execute the program instructions:
measure an AV interval corresponding to an interval between an atrial paced (Ap) event or an atrial sensed (As) event and a sensed ventricular (Vs) event;
set a candidate AV delay based on the AV interval and a bundle branch adjustment (BBA) value;
measure a QRS characteristic of interest (COI) while utilizing the candidate AV delay in connection with delivering a pacing therapy by the IMD;
adjust the BBA value and reset the candidate AV delay based on the BBA value as adjusted;
repeat the adjust, reset and measure to obtain a collection of QRS COIs and corresponding candidate AV delays;
select one of the candidate AV delays, that corresponds to a select one o

Assignees

• Pacesetter Inc

Inventors

• Li Wenwen
• Badie Nima
• Mcspadden Luke C
• Qiao Yun
• Fischer Avi
• Ryu Kyungmoo

Classifications

• A61N1/36843

  Bi-ventricular stimulation · CPC title

• A61N1/3682 Primary

  with a variable atrioventricular delay · CPC title

• A61N1/0587

  Epicardial electrode systems; Endocardial electrodes piercing the pericardium · CPC title