Monitoring of His Bundle pacing capture during ventricular pacing therapy

1. A method for delivering a cardiac pacing therapy to a patient, comprising:

sensing a cardiac signal of the patient;

determining an occurrence of one of an intrinsic and a paced atrial depolarization event of a current cardiac cycle in response to the sensed cardiac signal;

delivering a first pacing therapy during the current cardiac cycle in response to the determined occurrence of the depolarization event, wherein the first pacing therapy comprising His Bundle pacing;

comparing an amplitude of the cardiac signal during a first time period within the current cardiac cycle subsequent to the delivered first pacing therapy to a predetermined amplitude threshold;

delivering a second pacing therapy within the current cardiac cycle and subsequent to the delivered first pacing therapy in response to the comparing,

wherein the second pacing therapy comprises ventricular pacing therapy; and

determining that intrinsic atrio-ventricular conduction is absent, wherein the His Bundle pacing is delivered having an AV delay between approximately 60 ms and 150 ms in response to intrinsic atrio-ventricular conduction being absent.

2. The method of claim 1 , further comprising

delivering the second pacing therapy in response to the amplitude not being more negative than the predetermined amplitude threshold.

3. The method of claim 2 , wherein the predetermined amplitude threshold is approximately −5 millivolts.

4. The method of claim 1 , wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy, delivering the second pacing therapy within a second time period subsequent to the first time period in response to the amplitude of the cardiac signal not being more negative than the amplitude threshold, wherein a sum of an AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period, and the second time period is less than an intrinsic AV interval associated with the patient.

5. The method of claim 4 , wherein the sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period and the second time period is less than a sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event and 40 ms in response to intrinsic atrio-ventricular conduction being absent.

6. The method of claim 5 , wherein the first time period is between approximately 5 milliseconds and 20 milliseconds and the second time period is between approximately 5 milliseconds and 10 milliseconds.

7. The method of claim 1 , wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy, and wherein the method further comprises

delivering the second pacing therapy within a second time period subsequent to the first time period in response to the cardiac signal not being more negative than the amplitude threshold.

8. The method of claim 7 , wherein the predetermined amplitude threshold is approximately −5 millivolts.

9. The method of claim 7 , wherein a sum of an AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period, and the second time period is less than an intrinsic AV-interval associated the patient.

10. The method of claim 9 , wherein the first time period is between approximately 5 milliseconds and 20 milliseconds and the second time period is between approximately 5 milliseconds and 10 milliseconds.

11. A system for delivering a cardiac pacing therapy to a patient, comprising:

a first cardiac lead having a distal end;

at least one electrode positioned at the distal end of the first cardiac lead to sense a cardiac signal of the patient and deliver a first cardiac pacing therapy;

a second cardiac lead having a distal end;

at least one electrode positioned at the distal end of the second cardiac lead to deliver a second cardiac pacing therapy; and

a processor configured to:

determine an occurrence of one of an intrinsic and a paced atrial depolarization event of a current cardiac cycle in response to the sensed cardiac signal,

deliver a first pacing therapy via the at least one electrode of the first cardiac lead during the current cardiac cycle in response to the determined occurrence of the depolarization event,

compare an amplitude of the cardiac signal during a first time period within the current cardiac cycle subsequent to the delivered first pacing therapy to a predetermined amplitude threshold,

delivering a second pacing therapy within the current cardiac cycle and subsequent to the delivered first pacing therapy via the at least one electrode of the second cardiac lead in response to the comparing in response to the amplitude not being more negative than the predetermined amplitude threshold.

12. The system of claim 11 , wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy.

13. The system of claim 11 , wherein the processor is configured to determine that intrinsic atrio-ventricular conduction is absent, wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy, and wherein the His Bundle pacing is delivered having an AV delay between approximately 60 ms and 150 ms in response to intrinsic atrio-ventricular conduction being absent.

14. The system of claim 11 , wherein the predetermined amplitude threshold is approximately −5 millivolts.

15. The system of claim 11 , wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy, and wherein the second pacing therapy is delivered within a second time period subsequent to the first time period, wherein a sum of an AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period, and the second time period is less than an intrinsic AV interval associated with the patient.

16. The system of claim 15 , wherein the processor is configured to determine that intrinsic atrio-ventricular conduction is absent, wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy, and wherein the sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period, and the second time period is less than a sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event and 40 ms in response to intrinsic atrio-ventricular conduction being absent.

17. The system of claim 11 , wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy, and wherein the second pacing therapy is delivered within a second time period subsequent to the first time period, wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy.

18. The system of claim 17 , wherein the first time period is between approximately 5 milliseconds and 20 milliseconds and the second time period is between approximately 5 milliseconds and 10 milliseconds.

19. A method for delivering a cardiac pacing therapy to a patient, comprising:

sensing a cardiac signal of the patient;

determining an occurrence of one of an intrinsic and a paced atrial depolarization event of a current cardiac cycle in response to the sensed cardiac signal;

delivering a first pacing therapy during the current cardiac cycle in response to the determined occurrence of the depolarization event;

comparing an amplitude of the cardiac signal during a first time period within the current cardiac cycle subsequent to the delivered first pacing therapy to a predetermined amplitude threshold;

delivering a second pacing therapy in response to the amplitude not being more negative than the predetermined amplitude threshold.

20. The method of claim 19 , wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy.

21. The method of claim 19 , wherein the predetermined amplitude threshold is approximately −5 millivolts.

22. The method of claim 19 , wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy, and wherein the second pacing therapy is delivered within a second time period subsequent to the first time period, wherein a sum of an AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period and the second time period is less than an intrinsic AV interval associated with the patient.

23. The method of claim 22 , further comprising determining that intrinsic atrio-ventricular conduction is absent, wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy, wherein the sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period and the second time period is less than a sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event and 40 ms in response to intrinsic atrio-ventricular conduction being absent.

24. A method for delivering a cardiac pacing therapy to a patient, comprising:

sensing a cardiac signal of the patient;

determining an occurrence of one of an intrinsic and a paced atrial depolarization event of a current cardiac cycle in response to the sensed cardiac signal;

delivering a first pacing therapy during the current cardiac cycle in response to the determined occurrence of the depolarization event;

comparing an amplitude of the cardiac signal during a first time period within the current cardiac cycle subsequent to the delivered first pacing therapy to a predetermined amplitude threshold, wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy;

delivering a second pacing therapy within the current cardiac cycle and subsequent to the delivered first pacing therapy in response to the amplitude of the cardiac signal not being more negative than the amplitude threshold, wherein the second pacing therapy is delivered within a second time period subsequent to the first time period, wherein a sum of an AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period, and the second time period is less than an intrinsic AV interval associated with the patient.

25. The method of claim 24 , wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy.

26. The method of claim 24 , further comprising determining that intrinsic atrio-ventricular conduction is absent, wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy, wherein the His Bundle pacing is delivered having an AV delay between approximately 60 ms and 150 ms in response to intrinsic atrio-ventricular conduction being absent.

27. The method of claim 24 , wherein the predetermined amplitude threshold is approximately −5 millivolts.

28. The method of claim 24 , wherein the first time period is between approximately 5 milliseconds and 20 milliseconds and the second time period is between approximately 5 milliseconds and 10 milliseconds.

29. A system for delivering a cardiac pacing therapy to a patient, comprising:

a first cardiac lead having a distal end;

at least one electrode positioned at the distal end of the first cardiac lead to sense a cardiac signal of the patient and deliver a first cardiac pacing therapy;

a second cardiac lead having a distal end;

at least one electrode positioned at the distal end of the second cardiac lead to deliver a second cardiac pacing therapy; and

a processor configured to:

determine an occurrence of one of an intrinsic and a paced atrial depolarization event of a current cardiac cycle in response to the sensed cardiac signal,

deliver a first pacing therapy via the at least one electrode of the first cardiac lead during the current cardiac cycle in response to the determined occurrence of the depolarization event,

compare an amplitude of the cardiac signal during a first time period within the current cardiac cycle subsequent to the delivered first pacing therapy to a predetermined amplitude threshold,

delivering a second pacing therapy within the current cardiac cycle and subsequent to the delivered first pacing therapy via the at least one electrode of the second cardiac lead in response to the comparing, and

determine that intrinsic atrio-ventricular conduction is absent, wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy, and wherein the His Bundle pacing is delivered having an AV delay between approximately 60 ms and 150 ms in response to intrinsic atrio-ventricular conduction being absent.

30. The system of claim 29 , wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy, and delivering the second pacing therapy within a second time period subsequent to the first time period in response to the amplitude of the cardiac signal not being more negative than the amplitude threshold, wherein a sum of an AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period, and the second time period is less than an intrinsic AV interval associated with the patient.

31. The system of claim 30 , wherein the sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period and the second time period is less than a sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event and 39 ms in response to intrinsic atrio-ventricular conduction being absent.

32. The system of claim 29 , wherein the first time period is between approximately 5 milliseconds and 20 milliseconds and the second time period is between approximately 5 milliseconds and 10 milliseconds.

33. The system of claim 29 , wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy, and delivering the second pacing therapy within a second time period subsequent to the first time period in response the amplitude of the cardiac signal not being more negative than the amplitude threshold, wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy.

34. A system for delivering a cardiac pacing therapy to a patient, comprising:

a first cardiac lead having a distal end;

at least one electrode positioned at the distal end of the first cardiac lead to sense a cardiac signal of the patient and deliver a first cardiac pacing therapy;

a second cardiac lead having a distal end;

at least one electrode positioned at the distal end of the second cardiac lead to deliver a second cardiac pacing therapy; and

a processor configured to:

determine an occurrence of one of an intrinsic and a paced atrial depolarization event of a current cardiac cycle in response to the sensed cardiac signal,

deliver a first pacing therapy via the at least one electrode of the first cardiac lead during the current cardiac cycle in response to the determined occurrence of the depolarization event,

compare an amplitude of the cardiac signal during a first time period within the current cardiac cycle subsequent to the delivered first pacing therapy to a predetermined amplitude threshold, wherein the first time period is subsequent to a blanking period associated with the delivered first pacing therapy,

deliver a second pacing therapy within the current cardiac cycle and subsequent to the delivered first pacing therapy via the at least one electrode of the second cardiac lead in response to the amplitude of the cardiac signal not being more negative than an amplitude threshold, wherein the second pacing therapy is delivered within a second time period subsequent to the first time period, wherein a sum of an AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period and the second time period is less than an intrinsic AV interval associated with the patient.

35. The system of claim 34 , wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy.

36. The system of claim 34 , wherein the predetermined amplitude threshold is approximately −5 millivolts.

37. The system of claim 34 , wherein the processor is configured to determine that intrinsic atrio-ventricular conduction is absent, wherein the first pacing therapy comprises His Bundle pacing and the second pacing therapy comprises ventricular pacing therapy, and wherein the sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event, the blanking period, the first time period, and the second time period is less than a sum of the AV interval at which the first pacing therapy is delivered relative to the determined atrial depolarization event and 39 ms in response to intrinsic atrio-ventricular conduction being absent.

38. The system of claim 34 , wherein the first time period is between approximately 5 milliseconds and 20 milliseconds and the second time period is between approximately 5 milliseconds and 10 milliseconds.