# US 10,441,795 B2 · System and method for assessing and selecting stimulation vectors in an implantable cardiac resynchronization therapy device

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- Number: US 10,441,795 B2
- Document ID: US10441795B2
- Status: Granted
- Kind: B2
- Application number: 15/861,895
- Filed: 2018-01-04
- Published: 2018-05-10
- Granted: 2019-10-15
- Earliest claimed: 2013-12-18
- Assignees: Cardiac Pacemakers, Inc.
- Applicants: Cardiac Pacemakers, Inc.
- Inventors: Yinghong Yu; Keith L. Herrmann; Holly E. Rockweiler; Sunipa Saha; Benjamin J Nyquist
- Web page: https://patentgrep.com/patent/US10441795B2

## CPC

- A61N 1/3686: {configured for selecting the electrode configuration on a lead (A61N1/3688 takes precedence)}
- A61N 1/36842: {Multi-site stimulation in the same chamber}
- A61N 1/37247: {User interfaces, e.g. input or presentation means}
- G16H 20/00: ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H 20/30: relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
- G16H 20/40: relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
- G16H 40/63: for local operation
- A61N 1/3684: {for stimulating the heart at multiple sites of the ventricle or the atrium}
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)
- G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA

## Abstract

Systems and methods for providing CRT therapy to a patient with an implanted multi-site pacing medical device. In one example, an intrinsic electrical delay associated with each of two or more left ventricle electrodes may be determined. The intrinsic electrical delay associated with each of the two or more left ventricle electrodes may be compared to an electrical delay threshold. If the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, a single left ventricle electrode may be selected for use during subsequent CRT therapy. If the electrical delay associated with more than one left ventricle electrode is greater than the electrical delay threshold, two or more of the left ventricle electrodes may be selected for use during subsequent CRT therapy.

## Claims

### Claim 1

A method of selecting stimulation vectors for a multi-site pacing medical device, the method comprising:
determining a pacing parameter associated with each of two or more left ventricle (LV) electrodes;
and
selecting a number of LV electrodes for use during subsequent CRT therapy, wherein the selecting includes determining whether the subsequent CRT therapy is single-site LV pacing stimulation or multi-site LV pacing stimulation using the determined pacing parameters and spacing information of the two or more LV electrodes.

### Claim 2 (depends on 1)

The method of claim 1, including:
comparing the determined pacing parameters to a specified parameter threshold and the determined spacings of the two or more LV electrodes to a specified spacing threshold,
wherein the electing the number of LV electrodes for use during subsequent CRT therapy includes changing the number of LV electrodes according to results of the comparing of the determined pacing parameters and the determined spacings of the two or more LV electrodes.

### Claim 3 (depends on 2)

The method of claim 2, including:
selecting LV electrodes for use during the subsequent CRT therapy according to the comparing of the pacing parameter to the specified parameter threshold; and
deselecting at least one of the selected LV electrodes for use during the subsequent CRT therapy when the spacing of the selected LV electrodes is less than the specified spacing threshold.

### Claim 4 (depends on 2)

The method of claim 2, including:
sensing an electrical cardiac activity signal using each of the two or more LV electrodes;
wherein the determining the pacing parameter includes determining a signal to noise ratio of the sensed electrical cardiac activity signal;
wherein the comparing the pacing parameter to the specified parameter threshold includes comparing the signal to noise ratio to a signal to noise ratio threshold; and
wherein the selecting the number of LV electrodes includes selecting the number of LV electrodes for use during subsequent CRT therapy according to the results of the comparing of the signal to noise ratio, and the comparing of the spacing of the LV electrodes.

### Claim 5 (depends on 2)

The method of claim 2,
wherein the determining the pacing parameter includes sensing an electrical impedance using each of the two or more LV electrodes;
wherein the comparing the pacing parameter to the specified parameter threshold includes comparing the electrical impedance to an electrical impedance threshold; and
wherein the selecting the number of LV electrodes includes selecting the number of LV electrodes for use during subsequent CRT therapy according to the results of the comparing of the electrical impedance, and the comparing of the spacing of the LV electrodes.

### Claim 6 (depends on 2)

The method of claim 2,
wherein the determining the pacing parameter includes determining an LV capture threshold using each of the two or more LV electrodes;
wherein the comparing the pacing parameter to the specified parameter threshold includes comparing the determined capture thresholds; and
wherein the selecting the number of LV electrodes includes selecting the number of LV electrodes for use during subsequent CRT therapy according to the results of the comparing of the LV capture thresholds, and the comparing of the spacing of the LV electrodes.

### Claim 7 (depends on 2)

The method of claim 2, including:
sensing a heart sound signal in association with delivering pacing stimulation using each of the two or more electrodes;
wherein the determining the pacing parameter includes determining heart sound signal strength;
wherein the comparing the pacing parameter to the specified parameter threshold includes comparing the heart sound signal strength to a heart sound signal strength threshold; and
wherein the selecting the number of LV electrodes includes selecting the number of LV electrodes for use during subsequent CRT therapy according to the results of the comparing of the heart sound signal strength, and the comparing of the spacing of the LV electrodes.

### Claim 8 (depends on 2)

The method of claim 2,
wherein the determining the pacing parameter includes determining an electrical delay associated with each of the two or more LV electrodes;
wherein the comparing the pacing parameter to the specified parameter threshold includes comparing the electrical delay associated with each of the two or more LV electrodes to an electrical delay threshold; and
wherein the selecting the number of LV electrodes includes selecting a first number of LV electrodes for use during subsequent CRT therapy when the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, and selecting a second number of the LV electrodes for use during subsequent CRT therapy when the electrical delay associated with more than one LV electrodes is greater than the electrical delay threshold.

### Claim 9 (depends on 8)

The method of claim 8, including:
sensing physical activity level information; and
wherein the determining the electrical delay associated with each of the two or more LV electrodes includes the determining the electrical delay when the physical activity level is less than a specified physical activity level.

### Claim 10 (depends on 1)

The method of claim 1,
wherein the determining the pacing parameter includes detecting whether phrenic nerve stimulation (PNS) results from pacing stimulation using the LV electrodes;
wherein the determining a spacing of each of the two or more LV electrodes relative to the other LV electrodes includes determining a position of the LV electrodes; and
wherein the selecting the number of LV electrodes includes selecting the number of LV electrodes for use during subsequent CRT therapy according to the detection of PNS and the position of the LV electrodes.

### Claim 11

A medical device system, comprising:
a controller configured to:
determine a pacing parameter associated with each of two or more left ventricle (LV) electrodes;
and
select a number of LV electrodes for use during subsequent CRT therapy using a determination of whether the subsequent CRT therapy is single-site LV pacing stimulation or multi-site LV pacing stimulation based on the determined pacing parameters and spacing information of the two or more LV electrodes.

### Claim 12 (depends on 11)

The medical device system of claim 11, wherein the controller is configured to:
compare the determined pacing parameters to a specified parameter threshold and the determined spacings of the two or more LV electrodes to a specified spacing threshold; and
change the number of LV electrodes for use during subsequent CRT therapy according to results of the comparing of the determined pacing parameters and the determined spacings of the two or more LV electrodes.

### Claim 13 (depends on 12)

The medical device system of claim 12, wherein the controller is configured to:
select LV electrodes for use during the subsequent CRT therapy according to the comparing of the pacing parameter to the specified parameter threshold; and
deselect at least one of the selected LV electrodes for use during the subsequent CRT therapy when the spacing of the selected LV electrodes is less than the specified spacing threshold.

### Claim 14 (depends on 12)

The medical device system of claim 12, including:
a heart sound sensor configured to sense a heart sound signal in association with delivering pacing stimulation using each of the two or more electrodes,
wherein the controller is configured to:
determine heart sound signal strength;
compare the heart sound signal strength to a heart sound signal strength threshold; and
select the number of LV electrodes for use during subsequent CRT therapy according to a result of the comparison of the heart sound signal strength and a result of the comparison of the spacing of the LV electrodes.

### Claim 15 (depends on 12)

The medical device system of claim 12, wherein the controller is configured to:
determine a signal to noise ratio of an electrical cardiac activity signal sensed using each of the two or more LV electrodes;
compare the signal to noise ratio to a signal to noise ratio threshold; and
select the number of LV electrodes for use during subsequent CRT therapy according to a result of the comparison of the signal to noise ratio and a result of the comparison of the spacing of the LV electrodes.

### Claim 16 (depends on 12)

The medical device system of claim 12, wherein the controller is configured to:
determine an electrical impedance using each of the two or more LV electrodes;
compare the electrical impedance to an electrical impedance threshold; and
select the number of LV electrodes for use during subsequent CRT therapy according to a result of the comparison of the electrical impedance and a result of the comparison of the spacing of the LV electrodes.

### Claim 17 (depends on 12)

The medical device system of claim 12, wherein the controller is configured to:
determine an LV capture threshold using each of the two or more LV electrodes;
select the number of LV electrodes for use during subsequent CRT therapy using the determined LV capture thresholds, and the spacing of the LV electrodes.

### Claim 18 (depends on 11)

The medical device system of claim 11, wherein the controller is configured to:
determine an electrical delay associated with each of the two or more LV electrodes;
compare the electrical delay associated with each of the two or more LV electrodes to an electrical delay threshold; and
select a first number of LV electrodes for use during subsequent CRT therapy when the electrical delay associated with one or fewer left ventricle electrodes is greater than the electrical delay threshold, and select a second number of the LV electrodes for use during subsequent CRT therapy when the electrical delay associated with more than one LV electrodes is greater than the electrical delay threshold.

### Claim 19 (depends on 18)

The medical device system of claim 18, wherein the electrical delay associated with each of the two or more left ventricle electrodes corresponds to one or both of a Q-LV delay and a RV-LV delay.

### Claim 20 (depends on 11)

The medical device system of claim 11, wherein the controller is configured to:
detect phrenic nerve stimulation (PNS) from delivery of pacing stimulation using the LV electrodes;
determine a position of the each of the two or more LV electrodes; and
select the number of LV electrodes for use during subsequent CRT therapy according to the detection of PNS and the position of the LV electrodes.