Systems and methods for leadless cardiac resynchrinization therapy

Patent metadata

Field	Value
Publication number	US-2015142070-A1
Application number	US-201414173328-A
Country	US
Kind code	A1
Filing date	Feb 5, 2014
Priority date	Nov 21, 2013
Publication date	May 21, 2015
Grant date	—

Abstract

Techniques and systems for monitoring cardiac arrhythmias and delivering electrical stimulation therapy using a subcutaneous device (e.g. subcutaneous implantable (SD)) is described. In one or more other embodiments, SD is implanted into a patient's heart. Electrical signals are then sensed which includes moderately lengthened QRS duration data from the patient's heart. A determination is made as to whether cardiac resynchronization pacing therapy (CRT pacing) is appropriate based upon the moderately lengthened QRS duration in the sensed electrical signals. The CRT pacing pulses are delivered to the heart using electrodes. In one or more embodiments, the SD can switch between fusion pacing and biventricular pacing based upon data (e.g. moderately lengthened QRS, etc.) sensed from the heart.

First claim

What is claimed is:

1 . A method comprising:
implanting a subcutaneous device (SD) in a patient's heart; implanting a leadless pacing device (LPD) in the patient's heart; sensing electrical signals which includes moderately lengthened QRS data from the patient's heart using the SD; employing the SD to determine whether cardiac resynchronization pacing therapy (CRT pacing) is appropriate based upon the QRS duration in the sensed electrical signals; employing the SD to determine timing of CRT pacing pulses for delivery to cardiac tissue through the LPD and sending signals indicative thereof to the LPD responsive to the sent indicative signals; delivering the CRT pacing pulses to the heart using the LPD; thereafter sensing subsequent electrical signals from the patient's heart using the SD; and determining, by the SD based on the subsequent electrical signals, whether the CRT pacing by the LPD provided efficacious resynchronization and whether the delivery and timing of subsequent CRT pacing pulses should be modified.

2 . A method of claim of 1 wherein the moderately lengthened QRS corresponds to a QRS width in the range of 120-160 ms.

3 . A method of claim 1 further comprising:
evaluating intrinsic ventricular conduction based upon the moderately lengthened QRS duration from a far-field EGM.

4 . A method of claim 1 further comprising:
evaluating RVs-LVs interval from the IMD sensing markers is automatically evaluated by the LPD or the SD.

5 . A method of claim 4 wherein RVs-LVs interval not exceeding 80 ms corresponds to fusion pacing while greater than 80 ms switches to biventricular pacing.

6 . A method of claim 1 wherein the SD generates a signal to the LPD to switch to another CRT.

7 . A method of claim 6 further comprising switching from the CRT pacing to another CRT pacing.

9 . A method of claim 7 wherein the SD generates a signal to the LPD cause switching from CRT pacing to another CRT pacing.

10 . A method of claim 9 wherein the CRT pacing and the another CRT pacing being one of fusion pacing and biventricular pacing.

11 . A method of claim 10 further comprising:
sensing another electrical signal from cardiac tissue via the LPD indicating fusion pacing being appropriate pacing to deliver to cardiac tissue; and
generating a signal to the SD from the LPD communicating fusion pacing data.

12 . A method of claim 11 further comprising:
processing the another electrical signal;
determining by the SD whether the another electrical signal indicates a switch CRT pacing should occur.

13 . A method of claim 7 wherein the SD generates a signal to the LPD confirming switching to another CRT pacing.

14 . A method of claim 13 wherein the CRT pacing being one of fusion pacing and biventricular pacing.

15 . A method of claim 13 further comprising:
generating an overriding signal from the SD to the LPD,

16 . A method of claim 15 wherein the SD generates a signal to the LPD confirming switching to another CRT pacing.

17 . A method of claim 1 further comprising:
sensing electrical signals from a substernally placed LPD.

18 . A method comprising:
implanting a subcutaneous device (SD) in a patient's heart; sensing electrical signals which includes moderately lengthened QRS duration data from the patient's heart; determining whether cardiac resynchronization pacing therapy (CRT pacing) is appropriate based upon the moderately lengthened QRS duration in the sensed electrical signals; and delivering the CRT pacing pulses to the heart using electrodes.

19 . A method of claim of 18 wherein the moderately lengthened QRS corresponds to a QRS width in the range of 120-160 ms.

20 . A method of claim 18 further comprising:
evaluating intrinsic ventricular conduction based upon the moderately lengthened QRS duration from a far-field EGM.

21 . A method of claim 18 further comprising:
evaluating RVs-LVs interval from the IMD sensing markers is automatically evaluated by the LPD or the SD.

22 . A method of claim 21 wherein RVs-LVs interval not exceeding 80 ms corresponds to fusion pacing while greater than 80 ms switches to biventricular pacing.

23 . A system for cardiac pacing comprising:
implanting means for implanting a subcutaneous device (SD) in a patient's heart; implanting means for implanting a leadless pacing device (LPD) in the patient's heart; sensing means for sensing electrical signals which includes moderately lengthened QRS data from the patient's heart using the SD; processing means for employing the SD to determine whether cardiac resynchronization pacing therapy (CRT pacing) is appropriate based upon the QRS duration in the sensed electrical signals; processing means for employing the SD to determine timing of CRT pacing pulses for delivery to cardiac tissue through the LPD and sending signals indicative thereof to the LPD responsive to the sent indicative signals; delivering means for delivering the CRT pacing pulses to the heart using the LPD; thereafter sensing means for sensing subsequent electrical signals from the patient's heart using the SD; and processing means for determining, by the SD based on the subsequent electrical signals, whether the CRT pacing by the LPD provided efficacious resynchronization and whether the delivery and timing of subsequent CRT pacing pulses should be modified.

24 . A system of claim of 23 wherein the moderately lengthened QRS corresponds to a QRS width in the range of 120-160 ms.

25 . A system of claim 23 further comprising:
evaluating intrinsic ventricular conduction based upon the moderately lengthened QRS duration from a far-field EGM.

26 . A system of claim 23 further comprising:
evaluating RVs-LVs interval from the IMD sensing markers is automatically evaluated by the LPD or the SD.

27 . A system of claim 26 wherein RVs-LVs interval not exceeding 80 ms corresponds to fusion pacing while greater than 80 ms switches to biventricular pacing.

Assignees

• Medtronic Inc

Inventors

• Sambelashvili Aleksandre T

Classifications

• A61N1/3684

  for stimulating the heart at multiple sites of the ventricle or the atrium · CPC title

• A61N1/36592

  controlled by the heart rate variability · CPC title

• A61N1/3682 Primary

  with a variable atrioventricular delay · CPC title

• A61N1/39622

  Pacing therapy · CPC title

• A61N1/3688 Primary

  configured for switching the pacing mode, e.g. from AAI to DDD · CPC title