Adjustable sensing in a His-bundle pacemaker
Systems and methods for pacing cardiac conductive tissue are described. An embodiment of a medical system includes an electrostimulation circuit to generate His-bundle pacing (HBP) pulses to stimulate a His bundle, and a cardiac event detector to detect a His-bundle activity within a time window following an atrial activity. The cardiac event detector may use a cross-chamber blanking, or an adjustable His-bundle sensing threshold, to avoid or reduce over-sensing of far-field atrial activity and inappropriate inhibition of HBP therapy. The electrostimulation circuit may deliver HBP in the presence of the His-bundle activity. The system may further recognize the detected His-bundle activity as either a FFPW or a valid inhibitory event, and deliver or withhold HBP therapy based on the recognition of the His-bundle activity.
1. A system for pacing a heart, comprising:
an electrostimulation circuit configured to generate His-bundle pacing (HBP) pulses to stimulate a His bundle of the heart;
a cardiac event detector configured to:
detect an atrial activity;
sense a physiologic signal from a His-bundle region;
determine a His-bundle sensing window following the detected atrial activity, the His-bundle sensing window shorter than a programmed atrial-to-ventricular delay and longer than a patient-specific intrinsic AH interval; and
detect a His-bundle activity from the sensed physiologic signal during the determined His-bundle sensing window; and
a control circuit configured to control the electrostimulation circuit to deliver the HBP pulses if no His-bundle activity is detected within the determined His-bundle sensing window, and to withhold the HBP pulses if the His-bundle activity is detected within the time His-bundle sensing window.
2. The system of claim 1 , wherein the cardiac event detector is configured to switch from a first sensing mode to a second sensing mode to detect the His-bundle activity in response to an indication of HBP, the second sensing mode having a lower sensitivity than the first sensing mode.
3. The system of claim 2 , wherein the first sensing mode includes a first sensing threshold and the second sensing mode includes a second sensing threshold higher than the first sensing threshold.
4. The system of claim 2 , further comprising an arrhythmia detector configured to detect a cardiac arrhythmia, wherein the cardiac event detector is configured to switch to the first sensing mode in response to the detected cardiac arrhythmia.
5. The system of claim 1 , wherein the atrial activity includes an atrial sensed event or an atrial paced event.
6. The system of claim 1 , wherein the cardiac event detector is configured to detect the His-bundle activity following a post-atrial cross-chamber blanking period that begins following the atrial activity.
7. The system of claim 6 , wherein the cardiac event detector is configured to detect the His-bundle activity following the post-atrial cross-chamber blanking period further using an adjustable sensing threshold.
8. The system of claim 1 , comprising a His-bundle activity detector configured to recognize the detected His-bundle activity as an inhibitory event or a far-field P-wave (FFPW), wherein the control circuit is configured to program the electrostimulation circuit to deliver the HBP pulses if the detected His-bundle activity is recognized as a FFPW, and to withhold the HBP pulses if the detected His-bundle activity is recognized as an inhibitory event;
wherein the inhibitory event includes a conducted His-bundle response, a far-field conducted R-wave, or a premature ventricular contraction.
9. The system of claim 8 , wherein the His-bundle activity detector is configured to recognize the detected His-bundle activity as an inhibitory event or a FFPW using a timing of the detected His-bundle activity.
10. The system of claim 9 , wherein the timing of the detected His-bundle activity includes an atrial-to-His interval (AHI) between the atrial activity and the detected His-bundle activity, and wherein the His-bundle activity detector is configured to recognize the detected His-bundle activity as a FFPW if the AHI is less than 50 milliseconds, or as an inhibitory event if the AHI exceeds 50 msec.
11. The system of claim 8 , wherein the His-bundle activity detector is configured to recognize the detected His-bundle activity as an inhibitory event or a FFPW using a morphology of the detected His-bundle activity.
12. The system of claim 8 , wherein the cardiac event detector is configured to adjust an event sensing threshold based on the detected FFPW to detect the His-bundle activity.
13. A method for operating a pacing system to stimulate a heart, the method comprising:
detecting an atrial activity of the heart using a cardiac event detector;
sensing, via the cardiac event detector, a physiologic signal from a His-bundle region;
determining a His-bundle sensing window following the detected atrial activity, the His-bundle sensing window shorter than a programmed atrial-to-ventricular delay and longer than a patient-specific intrinsic AH interval;
detecting, via the cardiac event detector, a presence or absence of a His-bundle activity from the sensed physiologic signal during the determined His-bundle sensing window; and
delivering His-bundle pacing (HBP) pulses, via an electrostimulation circuit, to stimulate the His bundle of the heart if no His-bundle activity is detected within the determined His-bundle sensing window, or withholding the delivery of the HBP pulses if the His-bundle activity is detected within the determined His-bundle sensing window.
14. The method of claim 13 comprising switching from a first sensing mode to a second sensing mode to detect the His-bundle activity in response to an indication of HBP, the second sensing mode having a lower sensitivity than the first sensing mode.
15. The method of claim 14 , wherein the first sensing mode includes a first sensing threshold and the second sensing mode includes a second sensing threshold higher than the first sensing threshold.
16. The method of claim 14 , comprising:
detecting a cardiac arrhythmia; and
switching to the first sensing mode to detect the His-bundle activity in response to the detected cardiac arrhythmia.
17. The method of claim 13 , wherein detecting the presence or absence of the His-bundle activity is during a post-atrial cross-chamber blanking period that begins following the sensed atrial activity.
18. The method of claim 13 , comprising:
recognizing the His-bundle activity detected within the determined His-bundle sensing window as an inhibitory event or a far-field P-wave (FFPW); and
delivering the HBP pulses if the detected His-bundle activity is recognized as a FFPW, or withholding the delivery of the HBP pulses if the detected His-bundle activity is recognized as an inhibitory event;
wherein the inhibitory event includes a conducted His-bundle response, a far-field conducted R-wave, or a premature ventricular contraction.
19. The method of claim 18 , comprising:
adjusting an event sensing threshold based on the detected FFPW; and
detecting the presence or absence of the His-bundle activity using the adjusted event sensing threshold.
20. The system of claim 1 , wherein the determined His-bundle sensing window is further shorter than a sensed P wave-to-R wave interval.