Guiding anti-tachyarrhythmia pacing train design and electrode selection with electrograms

Patent metadata

Field	Value
Publication number	US-12083344-B2
Application number	US-202117493539-A
Country	US
Kind code	B2
Filing date	Oct 4, 2021
Priority date	Nov 24, 2020
Publication date	Sep 10, 2024
Grant date	Sep 10, 2024

Abstract

An example medical device system includes therapy delivery circuitry configured to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient via electrodes communicatively coupled to the therapy delivery circuitry. The ATP therapy includes one or more ATP trains. The medical device system also includes processing circuitry configured determine a first propagation time based on a comparison of features in a local electrogram and a far-field electrogram, such as the time from a fiducial point in the local electrogram and QRS onset in the far-field electrogram. The processing circuitry is also configured to determine, based on the first propagation time, a number of pulses to achieve a second propagation time and control the therapy delivery circuitry to deliver the ATP train of at least the number of pulses.

First claim

What is claimed is:

1. A method comprising:
determining, by a medical device system, a first feature in a local electrogram;
determining, by the medical device system, a second feature in a far-field electrogram;
determining, by the medical device system, a first propagation time based on the first feature and the second feature;
determining, by the medical device system, that a first predetermined propagation time range of a plurality of predetermined propagation time ranges is associated with the first propagation time;
selecting, by the medical device system and based on the first predetermined propagation time range being associated with the first propagation time, a number of pulses of an anti-tachycardia pacing (ATP) train to achieve a second propagation time, the number of pulses being associated with the first predetermined propagation time range; and
delivering, by the medical device system, the ATP train of at least the number of pulses.

2. The method of claim 1 , wherein the first feature is an activation point.

3. The method of claim 1 , wherein the second feature is a QRS onset.

4. The method of claim 1 , wherein determining that the first predetermined propagation time range is associated with the first propagation time comprises at least one of:
determining whether the first propagation time is less than 10 milliseconds;
determining whether the first propagation time is between 10 milliseconds and 40 milliseconds; or
determining whether the first propagation time is more than 40 milliseconds.

5. The method of claim 4 , wherein the first propagation time is less than 10 milliseconds and the second propagation time is 100 milliseconds.

6. The method of claim 4 , wherein the first propagation time is between 10 milliseconds and 40 milliseconds, and the second propagation time is 150 milliseconds.

7. The method of claim 4 , wherein the first propagation time is more than 40 milliseconds and the second propagation time is 210 milliseconds.

8. The method of claim 1 , wherein the ATP train is a first ATP train delivered during a ventricular tachycardia event.

9. A medical device system comprising:
therapy delivery circuitry configured to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient via electrodes communicatively coupled to the therapy delivery circuitry, the ATP therapy comprising an ATP train; and
processing circuitry configured to:
determine a first feature in a local electrogram;
determine a second feature in a far-field electrogram;
determine a first propagation time based on the first feature and the second feature;
determine that a first predetermined propagation time range of a plurality of predetermined propagation time ranges is associated with the first propagation time;
select, based on the first predetermined propagation time range being associated with the first propagation time a number of pulses of the ATP train to achieve a second propagation time; and
control the therapy delivery circuitry to deliver the ATP train of at least the number of pulses.

10. The medical device system of claim 9 , wherein the first feature is an activation point.

11. The medical device system of claim 9 , wherein the second feature is a QRS onset.

12. The medical device system of claim 9 , wherein, as part of determining the first predetermined propagation time range is associated with the first propagation time, the processing circuitry is configured to determine at least one of:
whether the first propagation time is less than 10 milliseconds;
whether the first propagation time is between 10 milliseconds and 40 milliseconds; or
whether the first propagation time is more than 40 milliseconds.

13. The medical device system of claim 12 , wherein the first propagation time is less than 10 milliseconds and the second propagation time is 100 milliseconds.

14. The medical device system of claim 12 , wherein the first propagation time is between 10 milliseconds and 40 milliseconds and the second propagation time is 150 milliseconds.

15. The medical device system of claim 12 , wherein the first propagation time is more 40 milliseconds and the second propagation time is 210 milliseconds.

16. The medical device system of claim 9 , wherein the ATP train is a first ATP train delivered during a ventricular tachycardia event.

17. The medical device system of claim 9 wherein the processing circuitry is further configured to:
control a first electrode to pace a heart of a patient;
determine a third feature in a local electrogram in response to the pace;
determine, for each electrode of a plurality of other electrodes communicatively coupled to the medical device system, a respective fourth feature in a respective electrogram;
determine, for each of the plurality of other electrodes communicatively coupled to the medical device system, a respective propagation time based on the third feature and the respective fourth feature;
compare the respective propagation times associated with each of the plurality of other electrodes;
determine, based on the comparison, an electrode associated with a shortest respective propagation time;
select the electrode associated with the shortest respective propagation time for delivery of the ATP therapy; and
control the therapy delivery circuitry to deliver the ATP therapy via the selected electrode.

18. A non-transitory computer-readable storage medium having stored thereon instructions that, when executed, cause processing circuitry to:
determine a first feature in a local electrogram;
determine a second feature in a far-field electrogram;
determine a first propagation time based on the first feature and the second feature;
determine that a first predetermined propagation time range of a plurality of predetermined propagation time ranges is associated with the first propagation time;
select, based on the first predetermined propagation time range being associated with the first propagation time, a number of pulses of an antitachycardia pacing (ATP) train to achieve a second propagation time; and
control therapy delivery circuitry to deliver the ATP train of the at least the number of pulses.

Assignees

• Medtronic Inc

Inventors

• Jackson Troy E

Classifications

• A61N1/368

  comprising more than one electrode co-operating with different heart regions {(A61N1/3622, A61N1/3627 take precedence)} · CPC title

• A61N1/36507

  controlled by gradient or slope of the heart potential · CPC title

• A61N1/3621 Primary

  for treating or preventing abnormally high heart rate · CPC title

• A61N1/3624 Primary

  occurring in the atrium, i.e. atrial tachycardia · CPC title