Far-field P-wave sensing in near real-time for timing delivery of pacng therapy in a cardiac medical device and medical device system

1. A medical device system for controlling delivery of a ventricular pacing therapy during cardiac resynchronization therapy, comprising:

a sensing device configured to sense a cardiac signal and to emit a trigger signal in response to the sensed cardiac signal;

a therapy delivery device to receive the trigger signal and deliver the ventricular pacing to the patient in response to the emitted trigger signal; and

a processor positioned within the sensing device, the processor configured to identify a fiducial point of the cardiac signal sensed in real-time, set a window comprising a start point positioned a first distance prior to the fiducial point and an endpoint positioned a second distance subsequent to the fiducial point, the second distance being less than the first distance, determine a signal characteristic of the cardiac signal within the window, determine whether a P-wave is detected in response to the signal characteristic, determine whether a timer associated with an atrio-ventricular interval has expired, and emit a trigger signal via the sensing device, the trigger signal being received by the therapy delivery device and instructing the therapy delivery device to deliver the ventricular pacing timed off of a local maximum in response to the P-wave being detected and not timed off of the local maximum in response to the timer being expired.

2. The medical device system of claim 1 , wherein the processor is configured to determine a change in slope of the cardiac signal, and determine a local maximum of the cardiac signal as the fiducial point.

3. The medical device system of claim 1 , wherein the processor is configured to determine a peak-to-peak amplitude of the cardiac signal within the window, determine whether the peak-to-peak amplitude is within a slope threshold, determine the P-wave is present in response to the peak-to-peak slope being within the slope threshold, and determining whether the timer has expired in response to the peak-to-peak slope not being within the slope threshold.

4. The medical device system of claim 1 , wherein the processor is configured to determine a peak-to-peak amplitude of the cardiac signal within the window, determine whether the peak-to-peak amplitude is greater than a noise threshold, determine whether the peak-to-peak amplitude is greater than an amplitude threshold, determine whether the peak-to-peak amplitude is within a slope threshold, determine the P-wave is present in response to the peak-to-peak amplitude being greater than the noise threshold, the peak-to-peak amplitude not being greater than the amplitude threshold, and the peak-to-peak slope being within the slope threshold, and determining whether the timer has expired in response to one of the peak-to-peak amplitude not being greater than the noise threshold, the peak-to-peak amplitude being greater than the amplitude threshold, and the peak-to-peak slope not being within the slope threshold.

5. The medical device system of claim 4 , wherein the processor is configured to determine a change in slope of the cardiac signal, and determine a local maximum of the cardiac signal as the fiducial point.

6. The medical device system of claim 1 , wherein the sensing device comprises a subcutaneously implanted leadless device.

7. The medical device system of claim 1 , wherein the first distances comprises 120 ms and the second distance comprised 40 ms.

8. A medical device system for controlling delivery of a ventricular pacing therapy during cardiac resynchronization therapy, comprising:

a subcutaneous sensing device capable of being implanted subcutaneously within a patient configured to sense a cardiac signal and to emit a trigger signal in response to the sensed cardiac signal;

subcutaneously implanted electrodes position along the sensing device configured to sense the cardiac signal;

a therapy delivery device comprising a transcatheter intracardiac pacemaker adapted for implantation wholly within a heart chamber to receive the trigger signal and deliver the ventricular pacing to the patient in response to the emitted trigger signal; and

a processor positioned within the sensing device, the processor configured to identify a fiducial point of the cardiac signal sensed in real-time, set a window comprising a start point positioned a first distance prior to the fiducial point and an endpoint positioned a second distance subsequent to the fiducial point, the second distance being less than the first distance, determine a signal characteristic of the cardiac signal within the window, determine whether a P-wave is detected in response to the signal characteristic, determine whether a timer associated with an atrio-ventricular interval has expired, and emit a trigger signal via the sensing device, the trigger signal being received by the therapy delivery device and instructing the therapy delivery device to deliver the ventricular pacing timed off of a local maximum in response to the P-wave being detected and not timed off of the local maximum in response to the timer being expired.

9. The medical device system of claim 8 , wherein the processor is configured to determine a change in slope of the cardiac signal, and determine a local maximum of the cardiac signal as the fiducial point.

10. The medical device system of claim 8 , wherein the processor is configured to determine a peak-to-peak amplitude of the cardiac signal within the window, determine whether the peak-to-peak amplitude is within a slope threshold, determine the P-wave is present in response to the peak-to-peak slope being within the slope threshold, and determining whether the timer has expired in response to the peak-to-peak slope not being within the slope threshold.

11. The medical device system of claim 8 , wherein the processor is configured to determine a peak-to-peak amplitude of the cardiac signal within the window, determine whether the peak-to-peak amplitude is greater than a noise threshold, determine whether the peak-to-peak amplitude is greater than an amplitude threshold, determine whether the peak-to-peak amplitude is within a slope threshold, determine the P-wave is present in response to the peak-to-peak amplitude being greater than the noise threshold, the peak-to-peak amplitude not being greater than the amplitude threshold, and the peak-to-peak slope being within the slope threshold, and determining whether the timer has expired in response to one of the peak-to-peak amplitude not being greater than the noise threshold, the peak-to-peak amplitude being greater than the amplitude threshold, and the peak-to-peak slope not being within the slope threshold.

12. The medical device system of claim 11 , wherein the processor is configured to determine a change in slope of the cardiac signal, and determine a local maximum of the cardiac signal as the fiducial point.

13. The medical device system of claim 11 , wherein the first distances comprises 120 ms and the second distance comprised 40 ms.

14. A medical device system for controlling delivery of a ventricular pacing during cardiac resynchronization therapy, comprising:

a subcutaneous sensing device comprising subcutaneously implanted electrodes configured to sense a cardiac signal and an emitting device to emit a trigger signal to deliver the therapeutic stimulation pulses in response to the sensed cardiac signal; and

a processor positioned within the subcutaneous sensing device, the processor configured to identify a fiducial point of the cardiac signal sensed in real-time, set a window comprising a start point positioned a first distance prior to the fiducial point and an endpoint positioned a second distance subsequent to the fiducial point, the second distance being less than the first distance, determine a signal characteristic of the cardiac signal within the window, determine whether a P-wave is detected in response to the signal characteristic, determine whether a timer associated with an atrio-ventricular interval has expired, and emit a trigger signal via the sensing device, the trigger signal being received by the therapy delivery device and instructing the therapy delivery device to deliver the ventricular pacing timed off of a local maximum in response to the P-wave being detected and not timed off of the local maximum in response to the timer being expired.

15. The medical device system of claim 14 , wherein the processor is configured to determine a change in slope of the cardiac signal, and determine a local maximum of the cardiac signal as the fiducial point.

16. The medical device system of claim 14 , wherein the processor is configured to determine a peak-to-peak amplitude of the cardiac signal within the window, determine whether the peak-to-peak amplitude is within a slope threshold, determine the P-wave is present in response to the peak-to-peak slope being within the slope threshold, and determining whether the timer has expired in response to the peak-to-peak slope not being within the slope threshold.

17. The medical device system of claim 14 , wherein the processor is configured to determine a peak-to-peak amplitude of the cardiac signal within the window, determine whether the peak-to-peak amplitude is greater than a noise threshold, determine whether the peak-to-peak amplitude is greater than an amplitude threshold, determine whether the peak-to-peak amplitude is within a slope threshold, determine the P-wave is present in response to the peak-to-peak amplitude being greater than the noise threshold, the peak-to-peak amplitude not being greater than the amplitude threshold, and the peak-to-peak slope being within the slope threshold, and determining whether the timer has expired in response to one of the peak-to-peak amplitude not being greater than the noise threshold, the peak-to-peak amplitude being greater than the amplitude threshold, and the peak-to-peak slope not being within the slope threshold.

18. The medical device system of claim 17 , wherein the processor is configured to determine a change in slope of the cardiac signal, and determine a local maximum of the cardiac signal as the fiducial point.

19. The medical device system of claim 17 , wherein the first distances comprises 120 ms and the second distance comprised 40 ms.