Adaptive cardiac resynchronization therapy

摘要

Cardiac resynchronization therapy (CRT) delivered to a heart of a patient may be adjusted based on detection of a surrogate indication of the intrinsic atrioventricular conduction of the heart. In some examples, the surrogate indication is determined to be a sense event of the first depolarizing ventricle of the heart within a predetermined period of time following the delivery of a fusion pacing stimulus to the later depolarizing ventricle. In some examples, the CRT is switched from a fusion pacing configuration to a biventricular pacing configuration if the surrogate indication is not detected, and the CRT is maintained in a fusion pacing configuration if the surrogate indication is detected.

主权项

1. A system comprising:
an electrical stimulation module configured to deliver cardiac resynchronization pacing therapy to a heart of a patient; a sensing module; and a processor configured to control the electrical stimulation module to deliver a pacing stimulus to a first ventricle of the heart, and determine whether a surrogate indication of intrinsic conduction from an atrium of the heart of the patient is detected after the electrical stimulation module delivers the pacing stimulus to the first ventricle, the processor being configured to determine whether the surrogate indication of the intrinsic conduction from the atrium is detected by at least determining whether the sensing module detected activation of a second ventricle of the heart within a predetermined window of time immediately following delivery of the pacing stimulus to the first ventricle by the electrical stimulation module, and the processor being further configured to control the cardiac resynchronization therapy delivered by the electrical stimulation module to the patient based on whether the surrogate indication of intrinsic conduction is detected after the electrical stimulation module delivers the pacing stimulus to the first ventricle,wherein the processor is configured to determine whether the surrogate indication of intrinsic conduction from the atrium of the heart to the second ventricle of the heart of the patient is detected by at least:
determining an intrinsic atrioventricular (AV) conduction time measurement; determining an interval of time between an atrial pace or sense event and the activation of the second ventricle sensed via the sensing module; determining whether the interval of time is substantially equal to the intrinsic AV conduction time measurement; determining the surrogate indication of intrinsic conduction is detected in response to determining the interval of time is substantially equal to the intrinsic AV conduction time measurement; and determining the surrogate indication of intrinsic conduction is not detected in response determining the interval of time is not substantially equal to the intrinsic AV conduction time measurement.