# US 12,544,578 B2 · Ventricular conduction system pacing therapy control

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- Number: US 12,544,578 B2
- Document ID: US12544578B2
- Status: Granted
- Kind: B2
- Application number: 17/735,628
- Filed: 2022-05-03
- Published: 2022-11-17
- Granted: 2026-02-10
- Earliest claimed: 2021-05-14
- Assignees: Medtronic, Inc.
- Applicants: Medtronic, Inc.
- Inventors: Xiaohong Zhou; Wade M. Demmer; Robert W. Stadler
- Web page: https://patentgrep.com/patent/US12544578B2

## CPC

- A61N 1/36592: {controlled by the heart rate variability}
- A61N 1/3688: {configured for switching the pacing mode, e.g. from AAI to DDD}
- A61N 1/365: controlled by a physiological parameter, e.g. heart potential {(evoked response A61N1/371)}
- A61N 1/3712: {Auto-capture, i.e. automatic adjustment of the stimulation threshold}
- A61N 1/371: {Capture, i.e. successful stimulation}
- 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)

## Abstract

A medical device is configured to sense at least one cardiac electrical signal and generate pacing pulses according to a first pacing therapy by generating pacing pulses for delivery to a first combination of ventricular pacing sites including at least one ventricular conduction system pacing site. The medical device may be configured to determine a ventricular conduction condition based on a QRS signal feature of the sensed cardiac signal during the first pacing therapy. The medical device may change to a second pacing therapy different than the first pacing therapy based on the determined ventricular conduction condition.

## Claims

### Claim 1

A medical device, comprising:
a sensing circuit configured to sense at least one cardiac electrical signal;
a therapy delivery circuit configured to generate first pacing pulses according to a first pacing therapy by generating the first pacing pulses for delivery to a first combination of ventricular pacing sites for capturing the first combination of ventricular pacing sites during a first percentage of ventricular cycles of all ventricular cycles during a given time period, the first combination of ventricular pacing sites comprising at least a first ventricular conduction system pacing site; and
a control circuit configured to:
control the therapy delivery circuit to withhold a pacing pulse of the first pacing pulses from at least one ventricular pacing site of the first combination of ventricular pacing sites for at least one ventricular cycle;
determine a QRS signal feature from the at least one cardiac electrical signal sensed by the sensing circuit during the at least one ventricular cycle; and
determine a ventricular conduction condition by determining a normal intrinsic ventricular conduction condition based on the QRS signal feature;
wherein the therapy delivery circuit is further configured to generate second pacing pulses according to a second pacing therapy different than the first pacing therapy by generating the second pacing pulses for capturing the first combination of ventricular pacing sites during a second percentage of ventricular cycles that is less than the first percentage of ventricular cycles in response to the control circuit determining the normal intrinsic ventricular conduction condition.

### Claim 2 (depends on 1)

The medical device of claim 1, wherein the therapy delivery circuit is configured to generate the first pacing pulses for delivery to the first combination of ventricular pacing sites comprising at least the first ventricular conduction system pacing site by generating first pacing pulses for delivery to a left bundle branch.

### Claim 3 (depends on 1)

The medical device of claim 1, wherein
the control circuit is configured to
control the therapy delivery circuit to withhold a pacing pulse of the first pacing pulses from at least one ventricular pacing site by withholding a pacing pulse from each ventricular pacing site of the first combination of ventricular pacing sites.

### Claim 4 (depends on 1)

The medical device of claim 1, wherein:
the control circuit is further configured to:
determine a heart rate from the at least one cardiac electrical signal sensed by the sensing circuit; and
determine that the heart rate is less than a threshold rate; and
the therapy delivery circuit is configured to generate the second pacing pulses according to the second pacing therapy in response to the control circuit determining that the heart rate is less than the threshold rate.

### Claim 5 (depends on 1)

The medical device of claim 1, further comprising an activity sensor sensing a patient activity signal,
wherein the control circuit is further configured to:
determine a pacing rate based on the patient activity signal, and
determine when the pacing rate is less than a threshold rate; and
wherein the therapy delivery circuit is configured to generate the second pacing pulses according to the second pacing therapy in response to the control circuit determining that the pacing rate is less than the threshold rate.

### Claim 6 (depends on 1)

The medical device of claim 1, wherein:
the control circuit is further configured to determine a time of day; and
the therapy delivery circuit is configured to generate the second pacing pulses according to the second pacing therapy based on the time of day.

### Claim 7 (depends on 1)

The medical device of claim 1, wherein the therapy delivery circuit is configured to generate the first pacing pulses for delivery to the first combination of ventricular pacing sites by generating the first pacing pulses for delivery to the first ventricular conduction system pacing site and at least one of a second ventricular conduction system pacing site and a myocardial pacing site.

### Claim 8 (depends on 1)

The medical device of claim 1, wherein:
the control circuit is further configured to detect ventricular conduction block during the second pacing therapy; and
the therapy delivery circuit is configured to change from generating the second pacing pulses according to the second pacing therapy to generating the first pacing pulses according to the first pacing therapy in response to the control circuit detecting the ventricular conduction block during the second pacing therapy.

### Claim 9 (depends on 1)

The medical device of claim 1, wherein the therapy delivery circuit is configured to generate the second pacing pulses according to the second pacing therapy by generating the second pacing pulses for delivery to a second combination of ventricular pacing sites, wherein the second combination of ventricular pacing sites is different than the first combination of ventricular pacing sites.

### Claim 10 (depends on 9)

The medical device of claim 9, wherein the therapy delivery circuit is further configured to:
generate the first pacing pulses for delivery to the first combination of ventricular pacing sites by generating the first pacing pulses for delivery to the first ventricular conduction system pacing site and at least one of a second ventricular conduction system pacing site and a myocardial pacing site; and
generate the second pacing pulses according to the second pacing therapy by generating the second pacing pulses for delivery to the second combination of ventricular pacing sites comprising fewer ventricular pacing sites than the first combination of ventricular pacing sites.

### Claim 11 (depends on 1)

The medical device of claim 1,
wherein the therapy delivery circuit is configured to generate the second pacing pulses according to the second pacing therapy by generating the second pacing pulses for delivery to the first combination of ventricular pacing sites comprising only the first ventricular conduction system pacing site.

### Claim 12 (depends on 1)

The medical device of claim 1, wherein:
the therapy delivery circuit is further configured to generate each of the first pacing pulses according to the first pacing therapy by generating each of the first pacing pulses at an expiration of a pacing interval; and
the control circuit is further configured to:
control the therapy delivery circuit during the first pacing therapy to generate a test pacing pulse for delivery to at least one ventricular pacing site of the first combination of ventricular pacing sites at an expiration of each one of a plurality of test pacing intervals;
determine a QRS signal feature from the cardiac electrical signal sensed by the sensing circuit following each one of the plurality of test pacing pulses;
determine a corrected ventricular conduction block condition associated with one test pacing interval of the plurality of test pacing intervals based on the determined QRS signal features from the cardiac electrical signal sensed by the sensing circuit following each one of the plurality of test pacing pulses; and
set the pacing interval to the one test pacing interval associated with the corrected bundle branch block condition.

### Claim 13 (depends on 1)

The medical device of claim 1, wherein:
the therapy delivery circuit is further configured to deliver each of the first pacing pulses according to the first pacing therapy by generating each of the first pacing pulses at an expiration of a pacing interval; and
the control circuit is further configured to:
control the therapy delivery circuit during the first pacing therapy to generate a test pacing pulse to at least one ventricular pacing site of the first combination of ventricular pacing sites at an expiration of each one of a plurality of test pacing intervals;
determine a QRS signal feature from the cardiac electrical signal sensed by the sensing circuit following each one of the plurality of test pacing pulses; and
determine an uncorrected ventricular conduction block condition associated with each test pacing interval of the plurality of test pacing intervals based on the QRS signal features determined from the cardiac electrical signal sensed by the sensing circuit following each one of the plurality of test pacing pulses; and
wherein the therapy delivery circuit is configured to generate third pacing pulses according to a third pacing therapy different than the first pacing therapy in response to the control circuit determining the uncorrected ventricular conduction block condition, wherein the third pacing therapy comprises a third combination of ventricular pacing sites including more ventricular pacing sites than the first combination of ventricular pacing sites.

### Claim 14 (depends on 13)

The medical device of claim 13, wherein the therapy delivery circuit is configured to generate the third pacing pulses according to the third pacing therapy by generating the third pacing pulses for delivery to at least the first ventricular conduction system pacing site and at least one of a second ventricular conduction system pacing site and a ventricular myocardial pacing site.

### Claim 15 (depends on 13)

The medical device of claim 13, wherein the therapy delivery circuit is configured to set the pacing interval to one of an atrioventricular delay and a ventricular-to-ventricular delay.

### Claim 16 (depends on 1)

The medical device of claim 1, wherein the control circuit is configured to determine the QRS signal feature by determining at least one of:
a QRS width, a peak amplitude, a peak amplitude time, a maximum positive slope, a maximum negative slope, a maximum positive slope time, a maximum negative slope time, a QRS area, and a peak polarity.

### Claim 17 (depends on 1)

The medical device of claim 1, wherein:
the sensing circuit is configured to sense a first cardiac electrical signal from a first sensing electrode vector and a second cardiac electrical signal from a second sensing electrode vector;
the control circuit is further configured to determine the QRS signal feature by determining an activation time difference as a time interval from a first fiducial point of a first QRS signal of the first cardiac electrical signal to a second fiducial point of a second QRS signal of the second cardiac electrical signal; and
determine the ventricular conduction condition based on the activation time difference.

### Claim 18 (depends on 1)

The medical device of claim 1, wherein the control circuit is further configured to:
control the therapy delivery circuit during the first pacing therapy to generate a capture test pacing pulse for delivery to each ventricular pacing site of the first combination of ventricular pacing sites at a premature pacing interval; and
verify capture of each ventricular pacing site based on the at least one cardiac electrical signal sensed by the sensing circuit following each of the capture test pacing pulses.

### Claim 19 (depends on 1)

The medical device of claim 1, wherein:
the control circuit is further configured to:
control the therapy delivery circuit during the first pacing therapy to generate a capture test pacing pulse for delivery to each ventricular pacing site of the first combination of ventricular pacing sites at a premature pacing interval; and
determine loss of capture of at least one ventricular pacing site based on the at least one cardiac electrical signal sensed by the sensing circuit following each of the capture test pacing pulses; and
the therapy delivery circuit is configured to adjust at least one of a pacing pulse amplitude, pacing pulse width, and pacing electrode vector for delivering generated pacing pulses of the first pacing pulses to the at least one ventricular pacing site associated with the determined loss of capture.

### Claim 20 (depends on 1)

The medical device of claim 1 wherein:
the therapy delivery circuit is further configured to generate the first pacing pulses for delivery to the first combination of ventricular pacing sites by generating the first pacing pulses for delivery to at least two ventricular pacing sites comprising the first ventricular conduction system pacing site and a second ventricular pacing site; and
the control circuit is further configured to control the therapy delivery circuit to withhold a pacing pulse of the first pacing pulses from at least one ventricular pacing site of the first combination of ventricular pacing sites by withholding the pacing pulse from only the second ventricular pacing site of the first combination of ventricular pacing sites.

### Claim 21

A non-transitory, computer-readable medium storing a set of instructions which, when executed by a control circuit of a medical device, cause the medical device to:
sense at least one cardiac electrical signal;
generate first pacing pulses according to a first pacing therapy by generating the first pacing pulses for delivery to a first combination of ventricular pacing sites for capturing the first combination of ventricular pacing sites during a first percentage of ventricular cycles of all ventricular cycles during a given time period, the first combination of ventricular pacing sites comprising at least a first ventricular conduction system pacing site;
withhold a pacing pulse of the first pacing pulses from at least one ventricular pacing site of the first combination of ventricular pacing sites for at least one ventricular cycle;
determine a QRS signal feature from the at least one cardiac electrical signal sensed by the sensing circuit during the at least one ventricular cycle; and
determine a ventricular conduction condition by determining a normal intrinsic ventricular conduction condition based on the QRS signal feature; and
generate second pacing pulses according to a second pacing therapy different than the first pacing therapy by generating the second pacing pulses for capturing the first combination of ventricular pacing sites during a second percentage of ventricular cycles that is less than the first percentage of ventricular cycles in response to the control circuit determining the normal intrinsic ventricular conduction condition.