Efficient delivery of multi-site pacing

Patent metadata

Field	Value
Publication number	US-2016339248-A1
Application number	US-201615135288-A
Country	US
Kind code	A1
Filing date	Apr 21, 2016
Priority date	Apr 24, 2015
Publication date	Nov 24, 2016
Grant date	—

Abstract

An implantable device and associated method for delivering multi-site pacing therapy is disclosed. The device comprises a set of electrodes including a first ventricular electrode and a second ventricular electrode, spatially separated from one another and all coupled to an implantable pulse generator. The device comprises a processor configured for selecting a first cathode and a first anode from the set of electrodes to form a first pacing vector at a first pacing site along a heart chamber and selecting a second cathode and a second anode from the set of electrodes to form a second pacing vector at a second pacing site along the same heart chamber. The pulse generator is configured to deliver first pacing pulses to the first pacing vector and delivering second pacing pulses to the second pacing vector. The pulse generator generates a recharging current for recharging a first coupling capacitor over a first recharge time period in response to the first pacing pulses. The pulse generator for generating a recharging current for recharging a second coupling capacitor over a second recharge time period in response to the second pacing pulses. An order of recharging the first and second coupling capacitors is dependent upon one of ventricular pacing mode, left ventricle to right ventricle delay (V-V) pace delay, multiple point LV delay and latest delivered pacing pulses to one of the first and second pacing vectors.

First claim

1 . A pacing device comprising a set of electrodes including a first ventricular electrode and a second ventricular electrode, spatially separated from one another and all coupled to an implantable pulse generator, the device comprising:
a processor configured for selecting a first cathode and a first anode from the set of electrodes to form a first pacing vector at a first pacing site along a heart chamber and selecting a second cathode and a second anode from the set of electrodes to form a second pacing vector at a second pacing site along the same heart chamber; the pulse generator configured to deliver first pacing pulses to the first pacing vector and delivering second pacing pulses to the second pacing vector; the pulse generator for generating a recharging current for recharging a first coupling capacitor over a first recharge time period in response to the first pacing pulses; the pulse generator for generating a recharging current for recharging a second coupling capacitor over a second recharge time period in response to the second pacing pulses; and wherein an order of recharging the first and second coupling capacitors is dependent upon one of ventricular pacing mode, left ventricle to right ventricle delay, (V-V) pace delay, multiple point LV delay, and latest delivered pacing pulses to one of the first and second pacing vectors.

2 . The device of claim 1 wherein the recharging of the first coupling capacitor over the first recharge time period is in response to the first pacing pulses.

3 . The device of claim 1 wherein the recharging of the second coupling capacitor over the second recharge time period is in response to the second pacing pulses.

4 . The device of claim 1 wherein the first and second recharge time periods are not at a preset time period.

5 . The device of claim 1 wherein one of the first and second recharge time periods comprise a set of recharge time periods implemented before recharge is completed for one of the first and second recharge time periods.

6 . The device of claim 1 wherein one of the first and second recharge time periods have a same duration in time even if completion of recharge is interrupted by another pace pulse.

7 . The device of claim 16 , further comprising displaying on a graphical user interface an optimal pacing vector selected from one of the first pacing vector and the second pacing vector.

8 . The device of claim 7 , wherein an optimal pacing vector configuration comprises the first and the second left ventricular electrode that are spaced about 1.5 millimeters apart from each other.

9 . The device of claim 6 , wherein the first and second pacing vectors are the first and the second left ventricular electrode.

10 . The device of claim 1 , wherein the first and second pacing pulses are sequentially spaced apart during the same cardiac cycle.

11 . The device of claim 1 , wherein the first and second pacing vectors are selected to avoid phrenic nerve stimulation.

12 . The device of claim 1 , wherein the first and second pacing pulses is configured to be cardiac resynchronization therapy.

13 . The device of claim 1 , wherein the first pacing site being one of left ventricular tissue and right ventricular tissue.

14 . The device of claim 1 , wherein the second pacing site being one of left ventricular tissue and right ventricular tissue.

15 . The device of claim 1 , wherein the first and second pacing site being spaced apart along left ventricular tissue.

16 . A method for recharging a set of coupling capacitors associated with a right ventricular electrode and first and second left ventricular electrodes for delivery of multi-site pacing therapy, the method comprising:
setting one or more pacing parameters for controlling delivery of pacing pulses; generating a first pacing control signal from a timing control module to a switching matrix, the switching matrix comprising a first, second and third set of switches; in response to the first pacing control signal, the first set of switches causing discharging of a first output capacitor to deliver a first left ventricular (LV) pacing pulse to a first pacing vector; generating a second pacing control signal from the timing control module; in response to the second pacing control signal, the second set of switches causing discharging of a second output capacitor to deliver a second LV pacing pulse to a second pacing vector in response to the second pacing signal; generating a third pacing control signal from the timing control module to the switching matrix; in response to the third pacing control signal, the third set of switches causing discharging of a third output capacitor to deliver a right ventricular (RV) pacing pulse to a third pacing vector, wherein an order of recharging the first, second, and third coupling capacitors being dependent on the one or more programmable pacing parameters.

17 . The method of claim 16 wherein the one or more programmable pacing parameters comprises ventricular pacing mode, V-V pace delay, and multiple point left ventricular delay.

18 . The method of claim 16 , wherein in response to determining that:
(a) the ventricular pacing mode being RV→LV, (b) the V-V pace delay being about 2.5 ms, (c) the multiple point LV delay is greater than or equal to about 20 ms, recharging the second coupling capacitor in response to the second pacing pulse; recharging the first coupling capacitor in response to recharging the second coupling capacitor; and recharging the third coupling capacitor in response to the third pacing pulse.

19 . The method of claim 16 , wherein in response to determining that:
(a) the ventricular pacing mode being LV→RV, (b) the V-V pace delay being greater than or equal to about 20 ms, (c) the multiple point LV delay greater than or equal to about 10 ms, recharging the first coupling capacitor in response to the first pacing pulse; recharging the second coupling capacitor in response to the second pacing pulse; and recharging the third coupling capacitor in response to the RV pacing pulse.

20 . The method of claim 16 , wherein in response to determining that:
(a) the ventricular pacing mode being LV→RV, (b) the V-V pace delay being greater than or equal to about 20 ms, (c) the multiple point LV delay greater than or equal to about 2.5 ms, recharging the second coupling capacitor in response to the second pacing pulse; recharging the first coupling capacitor in response to recharging the second capacitor; and recharging the third coupling capacitor in response to the RV pacing pulse.

21 . The method of claim 16 , wherein in response to determining that:
(a) the ventricular pacing mode being LV→RV, (b) the V-V pace delay being greater than or equal to about 5 ms, (c) the multiple point LV delay greater than or equal to about 2.5 ms, recharging the third coupling capacitor in response to the RV pacing pulse; recharging the first coupling capacitor in response to recharging the third capacitor; and recharging the second coupling capacitor in response to recharging the first capacitor.

22 . The method of claim 16 , wherein recharging of the first coupling capacitor occurs over a time period that is not predetermined.

23 . The method of claim 16 , wherein recharging of the second coupling capacitor occurs over a time period that is not predetermined.

24 . The method of claim 16 , wherein recharging of the

Assignees

• Medtronic Inc

Inventors

• Schrock Anthony W
• Hudson Jean E
• Kleckner Karen J
• Wahlstrand John D
• Heinks Michael W
• Hudziak Michael L
• Ghosh Subham
• Sambelashvili Aleksandre T

Classifications

• A61N1/36514

  controlled by a physiological quantity other than heart potential, e.g. blood pressure (controlled by two or more physical parameters A61N1/36585) · CPC title

• A61N1/3712

  Auto-capture, i.e. automatic adjustment of the stimulation threshold · CPC title

• A61N1/36842

  Multi-site stimulation in the same chamber · CPC title

• A61N1/3686 Primary

  configured for selecting the electrode configuration on a lead (A61N1/3688 takes precedence) · CPC title

• A61N1/36571

  controlled by blood flow rate, e.g. blood velocity or cardiac output · CPC title