# US 12,539,423 B2 · His-bundle pacing for atrioventricular block

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- Number: US 12,539,423 B2
- Document ID: US12539423B2
- Status: Granted
- Kind: B2
- Application number: 17/939,931
- Filed: 2022-09-07
- Published: 2023-01-05
- Granted: 2026-02-03
- Earliest claimed: 2019-05-31
- Assignees: Cardiac Pacemakers, Inc.
- Applicants: Cardiac Pacemakers, Inc.
- Inventors: Allan Charles Shuros; David Arthur Casavant
- Web page: https://patentgrep.com/patent/US12539423B2

## CPC

- A61N 1/36585: {controlled by two or more physical parameters}
- A61N 1/3688: {configured for switching the pacing mode, e.g. from AAI to DDD}
- A61B 5/1102: {Ballistocardiography}
- A61B 5/364: Detecting abnormal ECG interval, e.g. extrasystoles, ectopic heartbeats
- 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)}
- A61B 5/7405: {using sound}
- A61B 5/746: {Alarms related to a physiological condition, e.g. details of setting alarm thresholds or avoiding false alarms}
- A61B 5/747: {in case of emergency, i.e. alerting emergency services}
- A61N 1/36507: {controlled by gradient or slope of the heart potential}
- A61N 1/36542: {controlled by body motion, e.g. acceleration}
- A61N 1/36592: {controlled by the heart rate variability}
- A61N 1/3682: {with a variable atrioventricular delay}
- A61B 5/0022: {Monitoring a patient using a global network, e.g. telephone networks, internet}
- A61B 5/0215: by means inserted into the body
- A61B 5/14542: {for measuring blood gases (A61B5/14551 takes precedence)}
- A61B 2562/0219: Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
- A61N 1/36578: {controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone}
- 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

Systems and methods for dynamically controlling His-bundle pacing (HBP) according to an indication of a rate-related or intermittent atrioventricular (AV) block in a subject are disclosed. An exemplary medical system includes an AV conduction monitor to detect an indication of either a presence or an absence of intermittent or rate-related AV conduction disturbance using physiologic information of the subject. In the event that an intermittent or rate-related AV conduction disturbance is present, a control circuit provides a control signal to an electrostimulation circuit to deliver HBP pulses. If there is no indication of intermittent or rate-related AV conduction disturbance, or a previously detected intermittent or rate-related AV conduction disturbance has been terminated, the control circuit withholds or discontinues delivery of the HBP pulses to promote intrinsic ventricular conduction and activation.

## Claims

### Claim 1

A system for electrically stimulating a physiologic conduction pathway of a heart of a patient, the system comprising:
an atrioventricular (AV) conduction monitor configured to:
receive heart rate information of the patient and physiologic information of the patient different than heart rate;
monitor a heart rate of the patient using the received heart rate information;
determine a personalized heart rate threshold of the patient at and above which an AV conduction disturbance occurs using the received physiological information; and
in response to the monitored heart rate exceeding the personalized heart rate threshold of the patient, determine a presence or an absence of the AV conduction disturbance using the received physiologic information of the patient;
an electrostimulation circuit configured to provide electrostimulation energy to an interventricular septum between left and right ventricles of the heart; and
a controller circuit configured to generate a control signal to the electrostimulation circuit to initiate electrostimulation of the interventricular septum in response to the determined presence of AV conduction disturbance, and to withhold or discontinue the electrostimulation of the interventricular septum in response to the determined absence of AV conduction disturbance.

### Claim 2 (depends on 1)

The system of claim 1, wherein, in response to the determined presence of AV conduction disturbance, the controller circuit is configured to generate the control signal to the electrostimulation circuit to initiate the electrostimulation of the interventricular septum to activate at least one of a left bundle branch, a right bundle branch, fascicles, or Purkinje fibers.

### Claim 3 (depends on 1)

The system of claim 1, wherein the electrostimulation circuit is electrically coupled to a lead comprising at least one electrode positioned at the interventricular septum to deliver the electrostimulation energy thereto.

### Claim 4 (depends on 1)

The system of claim 1, comprising a leadless electrostimulator device configured to be positioned at the interventricular septum to deliver the electrostimulation energy thereto, the leadless electrostimulator device comprising the electrostimulation circuit and at least one electrode electrically coupled to the electrostimulation circuit.

### Claim 5 (depends on 1)

The system of claim 1, wherein the monitored heart rate includes a sensor-indicated atrial pacing rate.

### Claim 6 (depends on 1)

The system of claim 1, wherein to monitor the heart rate, the AV conduction monitor is configured to sense a near-field atrial heart rate via an electrode within an atrium of the heart, or a far-field atrial heart rate via an electrode outside the atrium of the heart.

### Claim 7 (depends on 1)

The system of claim 1, wherein the AV conduction monitor is configured to determine the personalized heart rate threshold using intrinsic or paced AV conduction intervals of the patient at respective different heart rates.

### Claim 8 (depends on 7)

The system of claim 7, wherein to determine the personalized heart rate threshold, the AV conduction monitor is configured to:
detect, from each of the intrinsic or paced AV conduction intervals at the respective different heart rates, the presence or absence of AV conduction disturbance; and
determine the personalized heart rate threshold that corresponds to a transition between (i) the determined absence of AV conduction disturbance at a first heart rate and (ii) the determined presence of AV conduction disturbance at a different second heart rate.

### Claim 9 (depends on 1)

The system of claim 1, wherein:
the AV conduction monitor is configured to monitor the heart rate continuously or intermittently during the electrostimulation of the interventricular septum, and to detect the presence or absence of AV conduction disturbance; and
the controller circuit is configured to generate a control signal to the electrostimulation circuit to continue the electrostimulation of the interventricular septum in response to the determined presence of AV conduction disturbance, and to discontinue the electrostimulation of the interventricular septum in response to the determined absence of AV conduction disturbance.

### Claim 10 (depends on 1)

The system of claim 1, wherein the AV conduction monitor is configured to detect the presence or absence of intermittent AV conduction disturbance based on a comparison of a QRS width to a QRS width threshold.

### Claim 11 (depends on 1)

The system of claim 1, wherein the AV conduction monitor is configured to detect the presence or absence of intermittent AV conduction disturbance based on a comparison of a cardiac acceleration or heart sound metric to a threshold.

### Claim 12 (depends on 1)

The system of claim 1, wherein the AV conduction monitor is configured to detect the presence or absence of intermittent AV conduction disturbance based on a comparison of a cardiac timing metric to a threshold, the cardiac timing metric including at least one of a pre-ejection period, a systolic timing interval, a left-ventricular ejection time, or a diastolic timing interval.

### Claim 13

A method of electrically stimulating a physiologic conduction pathway of a heart of a patient, the method comprising:
receiving heart rate information of the patient and physiologic information of the patient different than heart rate;
monitoring a heart rate of the patient using the received heart rate information;
determining a personalized heart rate threshold of the patient at and above which an AV conduction disturbance occurs using the received physiological information; and
in response to the monitored heart rate exceeding the personalized heart rate threshold of the patient, determining a presence or an absence of the AV conduction disturbance using the received physiologic information; and
adjusting delivery of electrostimulation energy to an interventricular septum between left and right ventricles of the heart based on the determined presence or the determined absence of AV conduction disturbance, including:
initiating electrostimulation of the interventricular septum in response to the determined presence of AV conduction disturbance; and
withholding or discontinuing the electrostimulation of the interventricular septum in response to the determined absence of AV conduction disturbance.

### Claim 14 (depends on 13)

The method of claim 13, wherein in response to the determined presence of AV conduction disturbance, initiating the electrostimulation of the interventricular septum to activate at least one of a left bundle branch, a right bundle branch, fascicles, or Purkinje fibers.

### Claim 15 (depends on 13)

The method of claim 13, wherein in response to the determined presence of AV conduction disturbance, initiating the electrostimulation of the interventricular septum includes delivering the electrostimulation energy to at least one electrode positioned at the interventricular septum.

### Claim 16 (depends on 13)

The method of claim 13, wherein in response to the determined presence of AV conduction disturbance, initiating the electrostimulation of the interventricular septum includes delivering the electrostimulation energy using a leadless electrostimulator device positioned at the interventricular septum.

### Claim 17 (depends on 13)

The method of claim 13, wherein initiating the electrostimulation of the interventricular septum includes delivering the electrostimulation energy distal to a conduction disturbance or blockage activating at least one of a left bundle branch, a right bundle branch, fascicles, or Purkinje fibers.

### Claim 18

A leadless electrostimulator device configured to be positioned at an interventricular septum between left and right ventricles of a heart of a patient, the device comprising:
an atrioventricular (AV) conduction monitor configured to:
receive heart rate information of the patient and physiologic information of the patient different than heart rate;
monitor a heart rate of the patient using the received heart rate information;
determine a personalized heart rate threshold of the patient at and above which an AV conduction disturbance occurs using the received physiological information; and
in response to the monitored heart rate exceeding the personalized heart rate threshold of the patient, determine a presence or an absence of the AV conduction disturbance using the received physiologic information of the patient;
an electrostimulation circuit configured to provide electrostimulation energy to an interventricular septum between left and right ventricles of the heart; and
a controller circuit configured to generate a control signal to the electrostimulation circuit to initiate electrostimulation of the interventricular septum in response to the determined presence of AV conduction disturbance, and to withhold or discontinue the electrostimulation of the interventricular septum in response to the determined absence of AV conduction disturbance.

### Claim 19 (depends on 18)

The device of claim 18, wherein the AV conduction monitor is configured to monitor the heart rate continuously or intermittently during the electrostimulation of the interventricular septum, and to detect the presence or the absence of AV conduction disturbance; and the controller circuit is configured to generate a control signal to the electrostimulation circuit to continue the electrostimulation of the interventricular septum in response to the determined presence of AV conduction disturbance, and to discontinue the electrostimulation of the interventricular septum in response to the determined absence of AV conduction disturbance.

### Claim 20 (depends on 18)

The device of claim 18, wherein the controller circuit is configured to generate the control signal to the electrostimulation circuit to initiate the electrostimulation of the interventricular septum to activate at least one of a left bundle branch, a right bundle branch, fascicles, or Purkinje fibers.