# US 11,998,750 B2 · Implantable medical device and method for determining his bundle pacing capture > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 11,998,750 B2 - Document ID: US11998750B2 - Status: Granted - Kind: B2 - Application number: 18/069,227 - Filed: 2022-12-20 - Published: 2023-04-27 - Granted: 2024-06-04 - Earliest claimed: 2017-11-08 - Assignees: Medtronic, Inc. - Applicants: Medtronic, Inc. - Inventors: Todd J. Sheldon; Elizabeth A. Mattson; Eric R. Williams; Zhongping Yang; Shawn M. Campbell - Web page: https://patentgrep.com/patent/US11998750B2 ## CPC - A61N 1/371: {Capture, i.e. successful stimulation} - A61B 5/29: for permanent or long-term implantation - A61B 5/361: Detecting fibrillation - A61B 5/363: Detecting tachycardia or bradycardia - A61B 5/366: Detecting abnormal QRS complex, e.g. widening - A61B 5/4836: {Diagnosis combined with treatment in closed-loop systems or methods (A61B5/0036 takes precedence)} - A61B 5/686: {Permanently implanted devices, e.g. pacemakers, other stimulators, biochips (A61B5/6861 takes precedence)} - A61N 1/365: controlled by a physiological parameter, e.g. heart potential {(evoked response A61N1/371)} - A61N 1/3714: {Atrial capture} - A61N 1/37223: {Circuits for electromagnetic coupling} - A61N 1/37247: {User interfaces, e.g. input or presentation means} - A61N 1/3787: {from an external energy source} - A61N 1/3956: {Implantable devices for applying electric shocks to the heart, e.g. for cardioversion} - A61N 1/3756: {Casings with electrodes thereon, e.g. leadless stimulators} - 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) - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) ## Abstract An implantable medical device system receives a cardiac electrical signal produced by a patient's heart and comprising atrial P-waves and delivers a His bundle pacing pulse to the patient's heart via a His pacing electrode vector. The system determines a timing of a sensed atrial P-wave relative to the His bundle pacing pulse and determines a type of capture of the His bundle pacing pulse in response to the determined timing of the atrial P-wave. ## Claims ### Claim 1 A medical device, comprising: a sensing circuit configured to sense at least a first cardiac electrical signal produced by a heart via a first sensing electrode vector; a therapy delivery circuit configured to deliver a first pacing pulse having a first pacing pulse energy; and a control circuit configured to detect non-selective capture of both of myocardial tissue and at least a portion of a ventricular conduction system by the first pacing pulse based on an analysis of at least the first cardiac electrical signal by: determining a time interval from the first pacing pulse to a QRS signal of the first cardiac electrical signal; comparing the time interval to a first time interval threshold, the first time interval threshold being a selective capture time interval threshold corresponding to capture of the ventricular conduction system without capture of myocardial tissue; and detecting the non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system based on at least the time interval from the first pacing pulse to the QRS signal being less than the first time interval threshold. ### Claim 2 (depends on 1) The medical device of claim 1, wherein: the sensing circuit is further configured to sense a second cardiac electrical signal via a second sensing electrode vector different than the first sensing electrode vector; and the control circuit is further configured to detect the non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system based on the analysis of at least the first cardiac electrical signal and an analysis of the second cardiac electrical signal. ### Claim 3 (depends on 1) The medical device of claim 1, wherein the control circuit is further configured to detect the non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system by: determining a polarity of the first QRS signal; and determining that the polarity of the first QRS signal meets non-selective capture criteria. ### Claim 4 (depends on 1) The medical device of claim 1, wherein: the sensing circuit is further configured to sense a second cardiac electrical signal via a second sensing electrode vector different than the first sensing electrode vector; and the control circuit is further configured to: determine at least one feature of the second cardiac electrical signal; determine that the at least one feature of the second cardiac electrical signal meets non-selective capture criteria; and detect the non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system based on the time interval from the first pacing pulse to the first QRS signal being less than the first time interval threshold and the at least one feature of the second cardiac electrical signal meeting the non-selective capture criteria. ### Claim 5 (depends on 4) The medical device of claim 4, wherein the control circuit is further configured to determine the feature of the second cardiac electrical signal by determining at least one of a QRS width, a QRS area and a QRS morphology. ### Claim 6 (depends on 1) The medical device of claim 1, wherein: the therapy delivery circuit is further configured to deliver a plurality of pacing pulses including the first pacing pulse, the plurality of pacing pulses comprising a plurality of pacing pulse energies comprising the first pacing pulse energy; the control circuit is further configured to: determine, for each of the plurality of pacing pulses, if non-selective capture of both of myocardial tissue and at least a portion of the ventricular conduction system is detected; determine a lowest pulse energy of the plurality of pulse energies for which the non-selective capture is detected; and determine the lowest pulse energy as a non-selective capture threshold. ### Claim 7 (depends on 1) The medical device of claim 1, wherein: the sensing circuit is further configured to sense a second cardiac electrical signal via a second sensing electrode vector different than the first sensing electrode vector; the therapy delivery circuit is further configured to deliver a second pacing pulse having a second pacing pulse energy less than the first pacing pulse energy; the control circuit is further configured to: determine a loss of non-selective capture by the second pacing pulse based on an analysis of at least one of the first cardiac electrical signal and the second cardiac electrical signal; and determine, based on an analysis of at least one of the first cardiac electrical signal and the second cardiac electrical signal, a capture type of the second pacing pulse as being one of: selective capture of at least a portion of the ventricular conduction system without capturing myocardial tissue; or myocardial capture only without capture of the ventricular conduction system. ### Claim 8 (depends on 7) The medical device of claim 7, wherein the control circuit is further configured to: determine the first pacing pulse energy as a non-selective capture threshold in response to determining the loss of non-selective capture by the second pacing pulse; determine the first pacing pulse energy as a myocardial capture threshold in response to determining the capture type of the second pacing pulse as being selective capture; and determine the first pacing pulse energy as a ventricular conduction system capture threshold in response to determining the capture type of the second pacing pulse as being myocardial capture only. ### Claim 9 (depends on 7) The medical device of claim 7, wherein the control circuit is further configured to set a pacing pulse energy used by the therapy delivery circuit to deliver ventricular pacing based on the determined capture type of the second pacing pulse. ### Claim 10 (depends on 1) The medical device of claim 1 wherein the control circuit is further configured to detect selective capture of at least a portion of the ventricular conduction system without capture of the myocardial tissue based on at least the time interval from the first pacing pulse to the QRS signal being within a time interval range between the first time interval threshold and a second time interval threshold, the second time interval threshold being a loss of capture time interval threshold. ### Claim 11 A method, comprising: sensing at least a first cardiac electrical signal produced by a heart via a first sensing electrode vector; delivering a first pacing pulse having a first pacing pulse energy; and detecting non-selective capture of both of myocardial tissue and at least a portion of a ventricular conduction system by the first pacing pulse based on an analysis of at least the first cardiac electrical signal by: determining a time interval from the first pacing pulse to a QRS signal of the first cardiac electrical signal; comparing the time interval to a first time interval threshold, the first time interval threshold being a selective capture time interval threshold corresponding to capture of the ventricular conduction system without capture of myocardial tissue; and detecting the non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system based on at least the time interval from the first pacing pulse to the QRS signal being less than the first time interval threshold. ### Claim 12 (depends on 11) The method of claim 11, further comprising: sensing a second cardiac electrical signal via a second sensing electrode vector different than the first sensing electrode vector; and detecting the non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system based on the analysis of at least the first cardiac electrical signal and an analysis of the second cardiac electrical signal. ### Claim 13 (depends on 11) The method of claim 11, wherein the detecting the non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system comprises: determining a polarity of the QRS signal; and determining that the polarity of the QRS signal meets non-selective capture criteria. ### Claim 14 (depends on 11) The method of claim 11, further comprising: sensing a second cardiac electrical signal via a second sensing electrode vector different than the first sensing electrode vector; determining at least one feature of the second cardiac electrical signal; determining that the at least one feature of the second cardiac electrical signal meets non-selective capture criteria; and detecting the non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system based on the time interval from the first pacing pulse to the QRS signal being less than the first time interval threshold and the at least one feature of the second cardiac electrical signal meeting the non-selective capture criteria. ### Claim 15 (depends on 14) The method of claim 14, further comprising determining the feature of the second cardiac electrical signal by determining at least one of a QRS width, a QRS area and a QRS morphology. ### Claim 16 (depends on 11) The method of claim 11, further comprising: delivering a plurality of pacing pulses including the first pacing pulse, the plurality of pacing pulses comprising a plurality of pacing pulse energies comprising the first pacing pulse energy; determining, for each of the plurality of pacing pulses, if non-selective capture of both of myocardial tissue and at least the portion of the ventricular conduction system is detected; determining a lowest pulse energy of the plurality of pulse energies for which the non-selective capture is detected; and determining the lowest pulse energy as a non-selective capture threshold. ### Claim 17 (depends on 11) The method of claim 11, further comprising: sensing a second cardiac electrical signal via a second sensing electrode vector different than the first sensing electrode vector; delivering a second pacing pulse having a second pacing pulse energy less than the first pacing pulse energy; determining a loss of non-selective capture by the second pacing pulse based on an analysis of at least one of the first cardiac electrical signal and the second cardiac electrical signal; and determining, based on an analysis of at least one of the first cardiac electrical signal and the second cardiac electrical signal, a capture type of the second pacing pulse as being one of: selective capture of at least a portion of the ventricular conduction system without capturing myocardial tissue; or myocardial capture only without capture of the ventricular conduction system. ### Claim 18 (depends on 17) The method of claim 17, further comprising: determining the first pacing pulse energy as a non-selective capture threshold in response to determining the loss of non-selective capture by the second pacing pulse; determining the first pacing pulse energy as a myocardial capture threshold in response to determining the capture type of the second pacing pulse as being selective capture of at least a portion of the ventricular conduction system without capturing myocardial tissue; and determining the first pacing pulse energy as a ventricular conduction system capture threshold in response to determining the capture type of the second pacing pulse as being myocardial capture only without capture of the ventricular conduction system. ### Claim 19 (depends on 17) The method of claim 17 further comprising setting a pacing pulse energy for delivering ventricular pacing based on the determined capture type of the second pacing pulse.