His-bundle or bundle branch pacing capture verification
Systems and methods for pacing cardiac conductive tissue are described. In an embodiment, a medical system includes an electrostimulation circuit to generate pacing pulses to stimulate a His bundle or a bunch branch. A sensing circuit senses a far-field ventricular activation, determines a cardiac synchrony indicator using the far-field ventricular activation in response to His bundle or bundle branch pacing, and verifies His-bundle capture status using the determined cardiac synchrony indicator. The system can determine a pacing threshold using the capture status under different stimulation strength values. The electrostimulation circuit can deliver stimulation pulses in accordance with the determined pacing threshold.
1 . A system for pacing a cardiac conduction system of a heart, the system comprising:
an electrostimulation circuit configured to generate stimulation energy to pace the heart;
a sensing circuit configured to sense a far-field ventricular activity; and
a control circuit, configured to:
generate a control signal to the electrostimulation circuit to pace the cardiac conduction system including an interventricular septum of the heart;
determine a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity in response to the pacing of the cardiac conduction system (CSP); and
verify a capture status as a capture or a loss of capture (LOC) of the cardiac conduction system using the determined cardiac synchrony indicator,
wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the CSP,
wherein the control circuit is configured to:
determine the cardiac synchrony indicator based on a change or a rate of change in QRS width over time from the far-field electrogram; and
verify the capture of the cardiac conduction system when the change or the rate of change in QRS width is above or equal to a threshold, and the LOC of the cardiac conduction system when the change or the rate of change in QRS width is below the threshold.
2 . The system of claim 1 , wherein the sensing circuit is configured to sense the far-field ventricular activity using at least one epicardial or surface electrode.
3 . The system of claim 2 , wherein the at least one epicardial or surface electrode comprises an epicardial surface electrode.
4 . The system of claim 1 , wherein the CSP of the interventricular septum is delivered to activate at least one of a left bundle branch, a right bundle branch, fascicles, or Purkinje fibers.
5 . The system of claim 1 , wherein the electrostimulation circuit is electrically coupled to a lead comprising at least one electrode positioned at the interventricular septum to deliver the stimulation energy thereto.
6 . The system of claim 1 , comprising a leadless electrostimulator device configured to be positioned at the interventricular septum to deliver electrostimulation thereto, the leadless electrostimulator device comprising the electrostimulation circuit and at least one electrode electrically coupled to the electrostimulation circuit.
7 . The system of claim 1 , wherein the control circuit is configured to, in response to the loss of capture when pacing at a first interventricular septal site of the cardiac conduction system, control the electrostimulation circuit to pace a second interventricular septal site of the cardiac conduction system more distal than the first interventricular septal site.
8 . A system for pacing a cardiac conduction system of a heart, the system comprising:
an electrostimulation circuit configured to generate stimulation energy to pace the heart;
a sensing circuit configured to sense a far-field ventricular activity; and
a control circuit, configured to:
generate a control signal to the electrostimulation circuit to pace the cardiac conduction system at a first interventricular septal site of the heart;
determine a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity in response to pacing at the first interventricular septal site; and
verify a capture status as a capture or a loss of capture (LOC) using the determined cardiac synchrony indicator, and in response to the LOC, control the electrostimulation circuit to pace the cardiac conduction system at a second interventricular septal site of the heart different than the first interventricular septal site,
wherein the sensing circuit is further configured to sense cardiac mechanical activity information including at least one of one or more of heart sounds information, endocardial acceleration information, cardiac impedance information, or cardiac pressure information,
wherein the control circuit is configured to determine the cardiac synchrony indicator furth based on the sensed cardiac mechanical activity information in response to the pacing at the first interventricular septal site.
9 . The system of claim 8 , wherein the pacing at the first and the second interventricular septal sites are delivered to activate at least one of a left bundle branch, a right bundle branch, fascicles, or Purkinje fibers.
10 . The system of claim 8 , wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the pacing at the first interventricular septal site,
wherein the control circuit is configured to:
determine the cardiac synchrony indicator based on a QRS width from the far-field electrogram; and
verify the capture of the cardiac conduction system when the QRS width is below a threshold, and the LOC of the cardiac conduction system when the QRS width is above or equal to the threshold.
11 . The system of claim 8 , wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the pacing at the first interventricular septal site,
wherein the control circuit is configured to:
determine the cardiac synchrony indicator based on a change or a rate of change in QRS width over time from the far-field electrogram; and
verify the capture of the cardiac conduction system when the change or the rate of change in QRS width is above or equal to a threshold, and the LOC of the cardiac conduction system when the change or the rate of change in QRS width is below the threshold.
12 . A method of pacing a cardiac conduction system of a heart using a cardiac pacing system, the method comprising:
electrically stimulating the cardiac conduction system including an interventricular septum of the heart;
sensing a far-field ventricular activity in response to the stimulation of the cardiac conduction system;
determining a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity;
verifying a capture status as a capture or a loss of capture (LOC) using the determined cardiac synchrony indicator; and
sensing cardiac mechanical activity information in response to the stimulation of the cardiac conduction system, the cardiac mechanical activity information including at least one of one or more of heart sounds information, endocardial acceleration information, cardiac impedance information, or cardiac pressure information,
wherein determining the cardiac synchrony indicator is further based on the sensed cardiac mechanical activity information.
13 . The method of claim 12 , wherein electrically stimulating the cardiac conduction system includes electrically stimulating a first interventricular septal site of the cardiac conduction system, the method further comprising, in response to the LOC at the first interventricular septal site, electrically stimulating a second interventricular septal site of the cardiac conduction system more distal than the first interventricular septal site.
14 . The method of claim 12 , wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the stimulation of the cardiac conduction system,
wherein determining the cardiac synchrony indicator includes determining a QRS width from the far-field electrogram,
wherein verifying the capture status includes verifying the capture of the cardiac conduction system when the QRS width is below a threshold, and verifying the LOC of the cardiac conduction system when the QRS width is above or equal to the threshold.
15 . The method of claim 12 , wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the stimulation of the cardiac conduction system,
wherein determining the cardiac synchrony indicator includes determining a change or a rate of change in QRS width over time from the far-field electrogram,
wherein verifying the capture status includes verifying the capture of the cardiac conduction system when the change or the rate of change in QRS width is above or equal to a threshold, and verifying the LOC of the cardiac conduction system when the change or the rate of change in QRS width is below the threshold.
16 . A system for pacing a cardiac conduction system of a heart, the system comprising:
an electrostimulation circuit configured to generate stimulation energy to pace the heart;
a sensing circuit configured to sense a far-field ventricular activity; and
a control circuit, configured to:
generate a control signal to the electrostimulation circuit to pace the cardiac conduction system including an interventricular septum of the heart;
determine a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity in response to the pacing of the cardiac conduction system (CSP); and
verify a capture status as a capture or a loss of capture (LOC) of the cardiac conduction system using the determined cardiac synchrony indicator,
wherein the sensing circuit is further configured to sense cardiac mechanical activity information including at least one of one or more of heart sounds information, endocardial acceleration information, cardiac impedance information, or cardiac pressure information,
wherein the control circuit is configured to determine the cardiac synchrony indicator further based on the sensed cardiac mechanical activity information in response to the pacing at the first interventricular septal site.
17 . The system of claim 16 , wherein the sensing circuit is configured to sense the far-field ventricular activity using at least a chest electrode.
18 . A system for pacing a cardiac conduction system of a heart, the system comprising:
an electrostimulation circuit configured to generate stimulation energy to pace the heart;
a sensing circuit configured to sense a far-field ventricular activity; and
a control circuit, configured to:
generate a control signal to the electrostimulation circuit to pace the cardiac conduction system at a first interventricular septal site of the heart;
determine a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity in response to pacing at the first interventricular septal site; and
verify a capture status as a capture or a loss of capture (LOC) using the determined cardiac synchrony indicator, and in response to the LOC, control the electrostimulation circuit to pace the cardiac conduction system at a second interventricular septal site of the heart different than the first interventricular septal site,
wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the pacing at the first interventricular septal site,
wherein the control circuit is configured to:
determine the cardiac synchrony indicator based on a change or a rate of change in QRS width over time from the far-field electrogram; and
verify the capture of the cardiac conduction system when the change or the rate of change in QRS width is above or equal to a threshold, and the LOC of the cardiac conduction system when the change or the rate of change in QRS width is below the threshold.
19 . The system of claim 18 , wherein the sensing circuit is configured to sense the far-field ventricular activity using at least a chest electrode.
20 . A method of pacing a cardiac conduction system of a heart using a cardiac pacing system, the method comprising:
electrically stimulating the cardiac conduction system including an interventricular septum of the heart;
sensing a far-field ventricular activity in response to the stimulation of the cardiac conduction system;
determining a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity; and
verifying a capture status as a capture or a loss of capture (LOC) using the determined cardiac synchrony indicator,
wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the stimulation of the cardiac conduction system,
wherein determining the cardiac synchrony indicator includes determining a change or a rate of change in QRS width over time from the far-field electrogram,
wherein verifying the capture status includes verifying the capture of the cardiac conduction system when the change or the rate of change in QRS width is above or equal to a threshold, and verifying the LOC of the cardiac conduction system when the change or the rate of change in QRS width is below the threshold.