Evaluation of ventricle from atrium pacing therapy

1. A system comprising:

electrode apparatus comprising a plurality of external electrodes to monitor electrical activity from tissue of a patient and

computing apparatus comprising processing circuitry and coupled to the electrode apparatus and configured to:

monitor electrical activity using the plurality of external electrodes;

generate paced electrical heterogeneity information (EHI) based on the monitored electrical activity during delivery of ventricle from atrium (VfA) pacing therapy at one or more VfA paced settings, wherein the paced EHI is representative of at least one of mechanical cardiac functionality and electrical cardiac functionality; and

determine whether the one or more VfA paced settings for the VfA pacing therapy are acceptable based on the paced EHI.

2. The system of claim 1 , wherein the one or more VfA paced settings comprise at least one of a voltage, a pulse width, timing of a V-pacing relative to intrinsic or paced atrial timing, and pacing rate.

3. The system of claim 1 , wherein the one or more VfA paced settings comprises a location of at least one implantable electrode wherein the location comprises at least one of depth and angle.

4. The system of claim 1 , wherein the one or more VfA paced settings comprises at least one of a pacing polarity, a pacing vector, and a number of pacing electrodes used.

5. The system of claim 1 , wherein the system further comprises a VfA pacing therapy apparatus, wherein the VfA pacing therapy apparatus comprises a tissue-piercing electrode implantable from the triangle of Koch region of the right atrium through the right atrial endocardium and central fibrous body to deliver the VfA pacing therapy to the left ventricle in the basal and/or septal region of the left ventricular myocardium of the patient's heart.

6. The system of claim 5 , wherein the VfA paced settings comprises a location of the at least one implantable electrode proximate the high posterior basal and/or septal area of the left ventricle of the patient.

7. The system of claim 1 , wherein the plurality of external electrodes comprises surface electrodes positioned in an array configured to be located proximate skin of a torso of the patient.

8. The system of claim 1 , wherein the paced EHI comprises a metric of electrical heterogeneity,

wherein the determining whether the one or more VfA paced settings for the VfA pacing therapy are acceptable comprises determining that the one or more VfA paced settings are acceptable if the metric of electrical heterogeneity is less than or equal to a threshold.

9. The system of claim 1 , wherein the determining whether the one or more VfA paced settings for the VfA pacing therapy are acceptable comprises:

generating baseline EHI from the monitored electrical activity without delivery of the VfA pacing therapy;

comparing the baseline EHI to the paced EHI; and

determining that the one or more VfA paced settings are acceptable based on the comparison of the baseline EHI to the paced EHI.

10. The system of claim 1 , wherein the electrical heterogeneity information comprises at least one metric of electrical heterogeneity, wherein the at least one metric of electrical heterogeneity comprises anterior-septal activation times (ASAT), wherein ASAT comprises activation times monitored from external electrodes of the plurality of external electrodes that correspond to the anterior-septal region of the heart of the patient.

11. The system of claim 1 , wherein the electrical heterogeneity information comprises at least one metric of electrical heterogeneity, wherein the at least one metric of electrical heterogeneity comprises at least one of anterior-septal activation times (ASAT), a standard deviation of activation times (SDAT), a composite left ventricular activation time (LVAT), and a composite right ventricular activation time (RVAT).

12. The system of claim 1 , wherein the computing apparatus is further configured to adjust the one or more VfA paced settings for the VfA pacing therapy based on whether the VfA pacing therapy is acceptable; and

wherein the adjusted one or more VfA paced settings is determined to be acceptable in response to the VfA pacing therapy correcting a bundle branch block (BBB).

13. The system of claim 1 , wherein the computing apparatus is further configured to adjust the one or more VfA paced settings for the VfA pacing therapy based on whether the VfA pacing therapy is acceptable; and

wherein the adjusted one or more VfA paced settings is determined to be acceptable in response to the VfA pacing therapy completely engaging a Purkinje system of the heart of the patient.

14. A method comprising:

monitoring electrical activity from tissue of a patient using a plurality of external electrodes;

generating paced electrical heterogeneity information (EHI) based on the monitored electrical activity during delivery of ventricle from atrium (VfA) pacing therapy at one or more VfA paced settings, wherein the paced EHI is representative of at least one of mechanical cardiac functionality and electrical cardiac functionality; and

determining whether the one or more VfA paced settings for the VfA pacing therapy are acceptable based on the paced EHI.

15. The method of claim 14 , wherein the one or more VfA paced settings comprise at least one of a voltage, a pulse width, timing of a V-pacing relative to intrinsic or paced atrial timing, and pacing rate.

16. The method of claim 14 , wherein the one or more VfA paced settings comprises a location of at least one implantable electrode wherein the location comprises at least one of depth and angle.

17. The method of claim 14 , wherein the one or more VfA paced settings comprises at least one of a pacing polarity, a pacing vector, and a number of pacing electrodes used.

18. The method of claim 14 , wherein the delivery of the VfA pacing therapy is performed by a VfA pacing therapy apparatus, wherein the VfA pacing therapy apparatus comprises a tissue-piercing electrode implantable from the triangle of Koch region of the right atrium through the right atrial endocardium and central fibrous body to deliver the VfA pacing therapy to the left ventricle in the basal and/or septal region of the left ventricular myocardium of the patient.

19. The method of claim 18 , wherein the VfA paced settings comprises a location of the at least one implantable electrode proximate the high posterior basal and/or septal area of the left ventricle of the patient.

20. The method of claim 14 , wherein the plurality of external electrodes comprises surface electrodes positioned in an array configured to be located proximate skin of a torso of the patient.

21. The method of claim 14 , wherein the paced EHI comprises a metric of electrical heterogeneity,

wherein the determining whether the one or more VfA paced settings for the VfA pacing therapy are acceptable comprises determining that the one or more VfA paced settings are acceptable if the metric of electrical heterogeneity is less than or equal to a threshold.

22. The method of claim 14 , wherein the determining whether the one or more VfA paced settings for the VfA pacing therapy are acceptable comprises:

generating baseline EHI from the monitored electrical activity without delivery of the VfA pacing therapy;

comparing the baseline EHI to the paced EHI; and

determining that the one or more VfA paced settings are acceptable based on the comparison of the baseline EHI to the paced EHI.

23. The method of claim 14 , wherein the electrical heterogeneity information comprises at least one metric of electrical heterogeneity, wherein the at least one metric of electrical heterogeneity comprises anterior-septal activation times (ASAT), wherein ASAT comprises activation times monitored from external electrodes of the plurality of external electrodes that correspond to the anterior-septal region of the heart of the patient.

24. The method of claim 14 , wherein the electrical heterogeneity information comprises at least one metric of electrical heterogeneity, wherein the at least one metric of electrical heterogeneity comprises at least one of anterior-septal activation times (ASAT), a standard deviation of activation times (SDAT), a composite left ventricular activation time (LVAT), and a composite right ventricular activation time (RVAT).

25. The method of claim 14 , further comprising adjusting the one or more VfA paced settings for the VfA pacing therapy based on whether the VfA pacing therapy is acceptable; and

wherein the adjusted one or more VfA paced settings is determined to be acceptable in response to the VfA pacing therapy correcting a bundle branch block (BBB).

26. The method of claim 14 , wherein the computing apparatus is further configured to adjust the one or more VfA paced settings for the VfA pacing therapy based on whether the VfA pacing therapy is acceptable; and

wherein the adjusted one or more VfA paced settings is determined to be acceptable in response to the VfA pacing therapy completely engaging a Purkinje system of the heart of the patient.

27. A system comprising:

electrode apparatus comprising a plurality of external electrodes to monitor electrical activity from tissue of a patient; and

computing apparatus comprising processing circuitry and coupled to the electrode apparatus and configured to:

monitor electrical activity using the plurality of external electrodes during delivery of ventricle from atrium (VfA) pacing therapy;

generate electrical heterogeneity information (EHI) during delivery of VfA pacing therapy;

determine whether a VfA paced setting for the VfA pacing therapy is acceptable based on the EHI generated from the electrical activity using the VfA paced setting; and

adjust the paced setting for the VfA pacing therapy based on whether the VfA pacing therapy is acceptable.