Endocardial pacing relating to conduction abnormalities

1. A method for use in connection with ventricular pacing of a left ventricle of a heart from a pacing lead located in the right ventricle, the method comprising:

sensing ventricular function of the heart;

assessing the sensed ventricular function to determine whether a conduction abnormality exists, the assessing including declaring a conduction abnormality to exist when an intrinsic QRS width, measured in the absence of a delivered pacing pulse, exceeds a threshold value of at least 120 milliseconds;

providing the ventricular pacing, including at least partially concurrent opposite polarity pacing pulses at a right ventricular septum at or near a bundle of His, in response to determining a conduction abnormality exists; and

inhibiting the ventricular pacing, including at least partially concurrent opposite polarity pacing pulses at a right ventricular septum at or near a bundle of His, in response to determining a conduction abnormality does not exist.

2. The method of claim 1 , wherein the step of providing the ventricular pacing is implemented using two concurrent pulses that are of opposite polarity to respective electrodes.

3. The method of claim 1 , wherein the step of ventricular pacing is implemented by applying a pacing signal near a His bundle of the heart using concurrent opposite polarity pulses delivered at first and second electrodes that are separated from each other by about 4 mm.

4. The method of claim 1 , wherein the step of assessing includes determining a fractionation.

5. The method of claim 1 , wherein the step of assessing includes determining timing between activation of a late activation site of the left ventricle and a portion of a QRS complex.

6. The method of claim 1 , wherein the step of assessing includes determining a maximum rate of change in pressure seen in the left ventricle.

7. A system for use in connection with ventricular pacing of a left ventricle of a heart from a pacing lead located in the right ventricle, the system comprising:

a sensor for sensing ventricular function of the heart;

a processing arrangement for assessing the sensed ventricular function to determine whether a conduction abnormality exists, the assessing including declaring a conduction abnormality to exist when an intrinsic QRS width, measured in the absence of a delivered pacing pulse, exceeds a threshold value of at least 120 milliseconds;

a pacing circuit for

providing the ventricular pacing, including at least partially concurrent opposite polarity pacing pulses at a right ventricular septum at or near a bundle of His, in response to determining a conduction abnormality exists; and

inhibiting the ventricular pacing, including at least partially concurrent opposite polarity pacing pulses at a right ventricular septum at or near a bundle of His, in response to determining a conduction abnormality does not exist.

8. The system of claim 7 , wherein the system is arranged for implantation.

9. The system of claim 7 , wherein the pacing circuit provides two concurrent pulses of opposite polarity to respective electrodes.

10. The system of claim 7 , wherein the pacing is arranged to applying a pacing signal near a His bundle of the heart using concurrent opposite polarity pulses delivered at first and second electrodes that are separated from each other by about 4 mm.

11. The system of claim 7 , wherein the sensor provides data used to determine fractionation.

12. The system of claim 7 , wherein the sensor provides data used to determine timing between activation of a late activation site of the left ventricle and a portion of a QRS complex.

13. The system of claim 7 , wherein the sensor provides data used to determine a maximum rate of change in pressure seen in the left ventricle.