Adjustable sensing in a his-bundle pacemaker
Systems and methods for pacing cardiac conductive tissue are described. An embodiment of a medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses to stimulate a His bundle, and a cardiac event detector to detect a His-bundle activity within a time window following an atrial activity. The cardiac event detector may use a cross-chamber blanking, or an adjustable His-bundle sensing threshold, to avoid or reduce over-sensing of far-field atrial activity and inappropriate inhibition of HBP therapy. The electrostimulation circuit may deliver HBP in the presence of the His-bundle activity. The system may further recognize the detected His-bundle activity as either a FFPW or a valid inhibitory event, and deliver or withhold HBP therapy based on the recognition of the His-bundle activity.
1 . A system for pacing a patient's heart, comprising:
an electrostimulation circuit configured to provide electrostimulation energy to an interventricular septum between left and right ventricles of the patient's heart;
a cardiac event detector configured to:
receive atrial information and conduction system information sensed from the patient's heart;
determine a sensing window following atrial activity in the atrial information, the sensing window shorter than a programmed atrial-to-ventricular delay and longer than a patient-specific intrinsic conduction system delay with respect to the atrial activity; and
determine a presence or an absence of conduction system activity in the conduction system information in the determined sensing window; and
a control circuit configured to generate a control signal to the electrostimulation circuit to deliver electrostimulation energy to the interventricular septum in the absence of the conduction system activity in the sensing window, and to withhold delivery of the electrostimulation energy to the interventricular septum in the presence of the conduction system activity in the sensing window.
2 . The system of claim 1 , wherein the patient-specific intrinsic conduction system delay with respect to the atrial activity includes an intrinsic atrial to left bunch branch delay or an intrinsic atrial to right bundle branch delay.
3 . The system of claim 1 , wherein the electrostimulation circuit is configured to deliver the electrostimulation energy to the interventricular septum via one or more electrodes positioned at a septal location to activate at least one of a left bundle branch, a right bundle branch, fascicles, or Purkinje fibers.
4 . The system of claim 1 , wherein, in response to an indication of electrostimulation energy being delivered to the interventricular septum, the cardiac event detector is configured to switch from a first sensing mode to a second sensing mode with a lower sensitivity than the first sensing mode to determine the presence or the absence of conduction system activity in the determined sensing window.
5 . The system of claim 4 , wherein the first sensing mode includes a first sensing threshold and the second sensing mode includes a second sensing threshold higher than the first sensing threshold.
6 . The system of claim 4 , wherein the cardiac event detector is configured to detect a cardiac arrhythmia event, and to switch to the first sensing mode in a presence of the detected cardiac arrhythmia event.
7 . The system of claim 1 , wherein the cardiac event detector is configured to determine the presence or the absence of the conduction system activity using a comparison of the conduction system information in the determined sensing window to an adjustable threshold.
8 . The system of claim 1 , wherein the atrial activity includes an atrial sensed event or an atrial paced event.
9 . The system of claim 1 , wherein the cardiac event detector is configured to determine the presence or the absence of the conduction system activity in the determined sensing window following a post-atrial cross-chamber blanking period.
10 . The system of claim 1 , wherein, in the presence of the conduction system activity:
the cardiac event detector is configured to determine the conduction system activity as an inhibitory event including at least one of a far-field conducted R-wave or a premature ventricular contraction; and
the control circuit is configured to generate the control signal to the electrostimulation circuit to withhold delivery of the electrostimulation energy to the interventricular septum when the conduction system activity being determined as the inhibitory event.
11 . The system of claim 10 , wherein the cardiac event detector is configured to determine the conduction system activity as the inhibitory event using a timing of the conduction system activity or a morphology of the conduction system activity.
12 . The system of claim 10 , wherein, in the presence of the conduction system activity:
the cardiac event detector is configured to determine the conduction system activity as a far-field P-wave (FFPW); and
the control circuit is configured to generate the control signal to the electrostimulation circuit to deliver the electrostimulation energy to the interventricular septum when the conduction system activity is determined as the FFPW.
13 . The system of claim 1 , wherein the determined sensing window is further shorter than a sensed P wave-to-R wave interval.
14 . A method for operating a pacing system to stimulate a patient's heart, the method comprising:
receiving atrial information and conduction system information sensed from the patient's heart;
determining a sensing window following atrial activity in the atrial information, the sensing window shorter than a programmed atrial-to-ventricular delay and longer than a patient-specific intrinsic conduction system delay with respect to the atrial activity;
determining a presence or an absence of conduction system activity in the conduction system information in the determined sensing window; and
delivering electrostimulation energy via an electrostimulation circuit to an interventricular septum in the absence of the conduction system activity in the sensing window, and withholding delivery of the electrostimulation energy to the interventricular septum in the presence of the conduction system activity in the sensing window.
15 . The method of claim 14 , wherein the patient-specific intrinsic conduction system delay with respect to the atrial activity includes an intrinsic atrial to left bunch branch delay or an intrinsic atrial to right bundle branch delay.
16 . The method of claim 14 , wherein delivering electrostimulation energy to the interventricular septum includes applying the electrostimulation energy to one or more electrodes positioned at a septal location to activate at least one of a left bundle branch, a right bundle branch, fascicles, or Purkinje fibers.
17 . The method of claim 14 , comprising, in response to an indication of the electrostimulation energy being delivered to the interventricular septum, switching from a first sensing mode to a second sensing mode with a lower sensitivity than the first sensing mode to determine the presence or the absence of conduction system activity in the determined sensing window.
18 . The method of claim 17 , wherein the first sensing mode includes a first sensing threshold and the second sensing mode includes a second sensing threshold higher than the first sensing threshold.
19 . The method of claim 17 , comprising:
detecting a cardiac arrhythmia; and
switching to the first sensing mode to determine the presence or the absence of the conduction system activity in a presence of the detected cardiac arrhythmia.
20 . The method of claim 14 , comprising:
determine the conduction system activity as an inhibitory event or a far-field P-wave (FFPW), the inhibitory event including a far-field conducted R-wave or a premature ventricular contraction; and
delivering the electrostimulation energy to the interventricular septum when the conduction system activity is determined as the FFPW, or withholding the delivery of the electrostimulation energy to the interventricular septum when the conduction system activity is determined as the inhibitory event.