His-Purkinje system capture detection

Patent metadata

Field	Value
Publication number	US-12397163-B2
Application number	US-202318167795-A
Country	US
Kind code	B2
Filing date	Feb 10, 2023
Priority date	Jun 25, 2019
Publication date	Aug 26, 2025
Grant date	Aug 26, 2025

Abstract

A medical device is configured to sense a cardiac electrical signal and determine from the cardiac electrical signal at least one of a maximum peak amplitude of a positive slope of the cardiac electrical signal and a maximum peak time interval from a pacing pulse to the maximum peak amplitude. The device is configured to determine a capture type of the pacing pulse based on at least one or both of the maximum peak amplitude and the maximum peak time interval.

First claim

What is claimed is:

1. A medical device, comprising:
a sensing circuit configured to sense a cardiac electrical signal;
a control circuit configured to:
determine, from the cardiac electrical signal, at least an amplitude value of a maximum peak of a positive slope of the cardiac electrical signal; and
determine a capture type of a pacing pulse as being one of non-selective His-Purkinje system capture or ventricular myocardial capture only without capture of the His-Purkinje system based on at least the amplitude value of the maximum peak of the positive slope of the cardiac electrical signal;

a memory configured to store the determined capture type; and
a therapy delivery circuit configured to generate at least one pacing pulse having a pacing pulse output based on the determined capture type.

2. The medical device of claim 1 , wherein the control circuit is further configured to:
determine a maximum peak time interval from the pacing pulse to the maximum peak of the positive slope; and
determine the capture type of the pacing pulse as being one of non-selective His-Purkinje system capture or ventricular myocardial capture only without capture of the His-Purkinje system based on at least the amplitude value of the maximum peak of the positive slope of the cardiac electrical signal and the determined maximum peak time interval from the pacing pulse to the maximum peak amplitude of the positive slope.

3. The medical device of claim 2 , wherein the control circuit is further configured to:
determine a ratio of the maximum peak time interval to the amplitude value of the maximum peak of the positive slope;
compare the ratio to a threshold ratio;
determine the capture type as non-selective His-Purkinje system capture in response to the ratio being less than or equal to the threshold ratio; and
determine the capture type as ventricular myocardial capture only without capture of the His-Purkinje system in response to the ratio being greater than the threshold ratio.

4. The medical device of claim 3 , further comprising:
a therapy delivery circuit configured to deliver a test pacing pulse at a test pulse energy;
wherein the control circuit is configured to establish the threshold ratio by:
determining a reference maximum peak amplitude of a positive slope of the cardiac electrical signal and a reference maximum peak time interval from the test pacing pulse to the reference maximum peak amplitude;
determining a reference ratio of the reference maximum peak time interval to the reference maximum peak amplitude; and
establishing the threshold ratio based on the reference ratio.

5. The medical device of claim 1 , wherein the control circuit is further configured to determine the amplitude value of the maximum peak of the positive slope by determining a maximum positive peak amplitude that corresponds to a maximum positive slope of a negative portion the cardiac electrical signal.

6. The medical device of claim 1 , wherein the control circuit is configured to:
determine at least one evoked response signal feature from the cardiac electrical signal;
compare the at least one evoked response signal feature to a selective His-Purkinje system capture threshold requirement;
responsive to the at least one evoked response signal feature meeting the selective His-Purkinje system capture threshold requirement, detect selective His-Purkinje system capture by a pacing pulse; and
responsive to the at least one evoked response signal feature not meeting the selective His-Purkinje system capture threshold requirement, analyze the cardiac electrical signal for determining the capture type of the pacing pulse as being one of non-selective His-Purkinje system capture or ventricular myocardial capture only without capture of the His-Purkinje system.

7. The medical device of claim 1 wherein the control circuit is further configured to control the therapy delivery circuit to generate pacing pulses according to a capture threshold test in response to determining the capture type as being ventricular myocardial capture only without capture of the His-Purkinje system.

8. A method, comprising:
sensing a cardiac electrical signal by a sensing circuit of a medical device;
determining at least an amplitude value of a maximum peak of a positive slope of the cardiac electrical signal;
determining a capture type of a pacing pulse as being one of non-selective His-Purkinje system capture or ventricular myocardial capture only without capture of the His-Purkinje system based on at least the amplitude value of the maximum peak of the positive slope of the cardiac electrical signal;
storing the determined capture type in a memory of the medical device; and
generating at least one pacing pulse having a pacing pulse output based on the determined capture type.

9. The method of claim 8 , further comprising:
determining a maximum peak time interval from the pacing pulse to the maximum peak of the positive slope; and
determining the capture type of the pacing pulse as being one of non-selective His-Purkinje system capture or ventricular myocardial capture only without capture of the His-Purkinje system based on at least the amplitude value of the maximum peak of the positive slope of the cardiac electrical signal and the determined maximum peak time interval from the pacing pulse to the maximum peak of the positive slope.

10. The method of claim 8 , further comprising:
determining a ratio of the maximum peak time interval to the amplitude value of the maximum peak of the positive slope;
comparing the ratio to a threshold ratio;
determining the capture type as non-selective His-Purkinje system capture in response to the ratio being less than or equal to the threshold ratio; and
determining the capture type as ventricular myocardial capture only without capture of the His-Purkinje system in response to the ratio being greater than the threshold ratio.

11. The method of claim 10 , further comprising:
delivering a test pacing pulse at a test pulse energy;
establishing the threshold ratio by:
determining a reference maximum peak amplitude of a positive slope of the cardiac electrical signal and a reference maximum peak time interval from the test pacing pulse to the reference maximum peak amplitude;
determining a reference ratio of the reference maximum peak time interval to the reference maximum peak amplitude; and
establishing the threshold based on the reference ratio.

12. The method of claim 8 , further comprising determining the amplitude value of the maximum peak of the positive slope by determining a maximum positive peak amplitude that corresponds to a maximum positive slope of a negative portion the cardiac electrical signal.

13. The method of claim 8 , further comprising
determining at least one evoked response signal feature from the cardiac electrical signal;
comparing the at least one evoked response signal feature to a selective His-Purkinje system capture threshold requirement;
responsive to the at least one evoked response signal feature meeting the selective His-Purkinje system capture threshold requirement, detecting selective His-Purkinje system capture by a pacing pulse; and
responsive to the at least one evoked response signal feature not meeting the selective His-Purkinje system capture threshold requirement, analyzing the cardiac electrical signal for determining the capture type of the pacing pulse as being one of non-selective His-Purkinje system capture or ventricular myocardial capture only without capture of the His-Purkinje system.

14. The method of claim 8 , further comprising generating pacing pulse

Assignees

• Medtronic Inc

Inventors

• Cao Jian
• Demmer Wade M
• Lybarger Maureen E
• Mattson Elizabeth A
• Sheldon Todd J
• Yang Zhongping
• Zhou Xiaohong

Classifications

• A61N1/3704 Primary

  Circuits specially adapted therefor, e.g. for sensitivity control · CPC title

• A61N1/3714

  Atrial capture · CPC title

• A61N1/3706

  Pacemaker parameters (stimulation threshold A61N1/371) · CPC title

• G16H50/20

  for computer-aided diagnosis, e.g. based on medical expert systems · CPC title

• G16H40/63

  for local operation · CPC title