CARDIAC PACING WITH ANODAL STIMULATION DETECTION

摘要

Methods and device for determining a pacing vector for delivering an electrostimulation therapy are described. An implantable medical device may be configured to determine an anode capture threshold and a cathode capture threshold for a first anode and cathode pair of electrodes, switch a polarity of the first anode and cathode pair of electrodes, and determine an anode capture threshold and a cathode capture threshold for the first anode and cathode pair of electrodes having the switched polarity. The implantable medical device may be further configured to compare a cathodal capture threshold for the anode and cathode pair having the switched polarity to the anodal capture threshold of the first anode and cathode pair of electrodes and select either an anode or a cathode for delivering an electrostimulation therapy based at least in part on the comparison. Other methods and systems are also contemplated and described.

主权项

1. An implantable medical device comprising:
an electrostimulation energy delivery circuit configured to deliver a number of pacing pulses to a subject's heart via an electrode configuration comprising a first electrode and a second electrode; an evoked response (ER) sensing circuit configured to sense an ER signal of a subject in response to each of the delivered pacing pulses; and a processor circuit, coupled to the ER sensing circuit and the electrostimulation energy delivery circuit, wherein in an operating mode of the device, the processor circuit is configured to:
cause the electrostimulation energy delivery circuit to deliver a number of pacing pulses using a first polarity of the first electrode and the second electrode;cause the electrostimulation energy delivery circuit to adjust a pacing energy of the delivered pacing pulses over time, and monitor the ER signal via the evoked response (ER) sensing circuit until a change is detected that indicates a change in capture at the first electrode and/or at the second electrode; andonce a change is detected that indicates a change in capture at the first electrode and/or the second electrode, identify from the evoked response if capture is occurring at the second electrode but not the first electrode, and if so, cause the electrostimulation energy delivery circuit to switch the polarity of the first electrode and the second electrode to a second polarity, and if not, maintain the first polarity of the first electrode and the second electrode.