Posterior left bundle branch engagement

1. A system comprising:

an electrode apparatus comprising a plurality of posterior electrodes to monitor electrical activity from a posterior of a patient's torso; and

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

monitor electrical activity of the patient's heart using the plurality of posterior electrodes during delivery of cardiac therapy,

generate electrical heterogeneity information (EHI) based on the monitored electrical activity during delivery of cardiac therapy, wherein generating EHI based on the monitored electrical activity during delivery of cardiac therapy comprises generating a mean of posterior electrical activation times monitored by the posterior electrodes, and

determine a degree of posterior left bundle branch engagement by the cardiac therapy based on the generated EHI, wherein determining a degree of posterior left bundle branch engagement based on the generated EHI comprises determining that left bundle branch is sufficiently engaged if the mean of posterior electrical activation times monitored by the posterior electrodes is less than or equal to 30 milliseconds, intermediately-engaged if the mean of posterior electrical activation times monitored by the posterior electrodes is greater than 30 milliseconds and less than 50 milliseconds, or insufficiently-engaged if the mean of posterior electrical activation times monitored by the posterior electrodes is greater than or equal to 50 milliseconds.

2. The system of claim 1 , wherein generating EHI based on the monitored electrical activity during delivery of cardiac therapy comprises generating a percentage of early-activation electrical activation times monitored by the posterior electrodes that is less than an early-activation threshold.

3. The system of claim 2 , wherein the early-activation threshold is 35 milliseconds.

4. The system of claim 2 , wherein determining a degree of posterior left bundle branch engagement based on the generated EHI comprises determining that left bundle branch is sufficiently engaged if the percentage of early-activation electrical activation times is greater than 75 %, intermediately-engaged if the percentage of early-activation electrical activation times is greater than or equal to 50% and less than or equal to 75%, or insufficiently-engaged if the percentage of early-activation electrical activation times is less than 50%.

5. The system of claim 1 , wherein the cardiac therapy is ventricle-from-atrium (VfA) pacing therapy.

6. The system of claim 1 , wherein the computing apparatus is further configured to adjust the cardiac therapy to increase the degree of posterior left bundle branch engagement.

7. The system of claim 1 , wherein the plurality of posterior electrodes comprises a plurality of surface electrodes positioned in an array to be attached to the patient's skin.

8. A method comprising:

monitoring electrical activity of the patient's heart using a plurality of posterior electrodes from a posterior of a patient's torso during delivery of cardiac therapy;

generating electrical heterogeneity information (EHI) based on the monitored electrical activity during delivery of cardiac therapy, wherein generating EHI based on the monitored electrical activity during delivery of cardiac therapy comprises generating a mean of posterior electrical activation times monitored by the posterior electrodes; and

determining a degree of posterior left bundle branch engagement by the cardiac therapy based on the generated EHI, wherein determining a degree of posterior left bundle branch engagement based on the generated EHI comprises determining that left bundle branch is sufficiently engaged if the mean of posterior electrical activation times monitored by the posterior electrodes is less than or equal to 30 milliseconds, intermediately-engaged if the mean of posterior electrical activation times monitored by the posterior electrodes is greater than 30 milliseconds and less than 50 milliseconds, or insufficiently-engaged if the mean of posterior electrical activation times monitored by the posterior electrodes is greater than or equal to 50 milliseconds.

9. The method of claim 8 , wherein generating EHI based on the monitored electrical activity during delivery of cardiac therapy comprises generating a percentage of early-activation electrical activation times monitored by the posterior electrodes that is less than an early-activation threshold.

10. The method of claim 9 , wherein the early-activation threshold is 35 milliseconds.

11. The method of claim 9 , wherein determining a degree of posterior left bundle branch engagement based on the generated EHI comprises determining that left bundle branch is sufficiently engaged if the percentage of early-activation electrical activation times is greater than 75%, intermediately-engaged if the percentage of surrogate early-activation electrical activation times is greater than or equal to 50% and less than or equal to 75%, or insufficiently-engaged if the percentage of surrogate early-activation electrical activation times is less than 50%.

12. The method of claim 8 , wherein the cardiac therapy is ventricle-from-atrium (VfA) pacing therapy.

13. The method of claim 8 , the method further comprising adjusting the cardiac therapy to increase the degree of posterior left bundle branch engagement.

14. The method of claim 8 , wherein the plurality of posterior electrodes comprises a plurality of surface electrodes positioned in an array to be attached to the patient's skin.

15. A system comprising:

an electrode apparatus comprising a plurality of posterior electrodes to monitor electrical activity from a posterior of a patient's torso; and

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

monitor electrical activity of the patient's heart using the plurality of posterior electrodes during delivery of cardiac therapy,

generate electrical heterogeneity information (EHI) based on the monitored electrical activity during delivery of cardiac therapy, wherein generating EHI based on the monitored electrical activity during delivery of cardiac therapy comprises generating a percentage of early-activation electrical activation times monitored by the posterior electrodes that is less than an early-activation threshold, wherein the early-activation threshold is 35 milliseconds, and

determine a degree of posterior left bundle branch engagement by the cardiac therapy based on the generated EHI.

16. The system of claim 15 , wherein the cardiac therapy is ventricle-from-atrium (VfA) pacing therapy.

17. The system of claim 15 , wherein the computing apparatus is further configured to adjust the cardiac therapy to increase the degree of posterior left bundle branch engagement.

18. The system of claim 15 , wherein the plurality of posterior electrodes comprises a plurality of surface electrodes positioned in an array to be attached to the patient's skin.

19. A method comprising:

monitoring electrical activity of the patient's heart using a plurality of posterior electrodes from a posterior of a patient's torso during delivery of cardiac therapy;

generating electrical heterogeneity information (EHI) based on the monitored electrical activity during delivery of cardiac therapy, wherein generating EHI based on the monitored electrical activity during delivery of cardiac therapy comprises generating a percentage of early-activation electrical activation times monitored by the posterior electrodes that is less than an early-activation threshold, wherein the early-activation threshold is 35 milliseconds; and

determining a degree of posterior left bundle branch engagement by the cardiac therapy based on the generated EHI.

20. The method of claim 19 , the method further comprising adjusting the cardiac therapy to increase the degree of posterior left bundle branch engagement.

21. The method of claim 19 , wherein the plurality of posterior electrodes comprises a plurality of surface electrodes positioned in an array to be attached to the patient's skin.