His-bundle or bundle branch pacing capture verification

A system for pacing a cardiac conduction system of a heart, the system comprising:

• an electrostimulation circuit configured to generate stimulation energy to pace the heart;
• a sensing circuit configured to sense a far-field ventricular activity;
• and
• a control circuit, configured to:
• generate a control signal to the electrostimulation circuit to pace the cardiac conduction system at a first interventricular septal site of the heart;
• determine a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity in response to pacing at the first interventricular septal site;
• and
• verify a capture status as a capture or a loss of capture (LOC) using the determined cardiac synchrony indicator, and in response to the LOC, control the electrostimulation circuit to pace the cardiac conduction system at a second interventricular septal site of the heart different than the first interventricular septal site,
• wherein the sensing circuit is further configured to sense cardiac mechanical activity information including at least one of one or more of heart sounds information, endocardial acceleration information, cardiac impedance information, or cardiac pressure information,
• wherein the control circuit is configured to determine the cardiac synchrony indicator furth based on the sensed cardiac mechanical activity information in response to the pacing at the first interventricular septal site.

A method of pacing a cardiac conduction system of a heart using a cardiac pacing system, the method comprising:

• electrically stimulating the cardiac conduction system including an interventricular septum of the heart;
• sensing a far-field ventricular activity in response to the stimulation of the cardiac conduction system;
• determining a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity;
• verifying a capture status as a capture or a loss of capture (LOC) using the determined cardiac synchrony indicator;
• and
• sensing cardiac mechanical activity information in response to the stimulation of the cardiac conduction system, the cardiac mechanical activity information including at least one of one or more of heart sounds information, endocardial acceleration information, cardiac impedance information, or cardiac pressure information,
• wherein determining the cardiac synchrony indicator is further based on the sensed cardiac mechanical activity information.

A system for pacing a cardiac conduction system of a heart, the system comprising:

• an electrostimulation circuit configured to generate stimulation energy to pace the heart;
• a sensing circuit configured to sense a far-field ventricular activity;
• and
• a control circuit, configured to:
• generate a control signal to the electrostimulation circuit to pace the cardiac conduction system including an interventricular septum of the heart;
• determine a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity in response to the pacing of the cardiac conduction system (CSP);
• and
• verify a capture status as a capture or a loss of capture (LOC) of the cardiac conduction system using the determined cardiac synchrony indicator,
• wherein the sensing circuit is further configured to sense cardiac mechanical activity information including at least one of one or more of heart sounds information, endocardial acceleration information, cardiac impedance information, or cardiac pressure information,
• wherein the control circuit is configured to determine the cardiac synchrony indicator further based on the sensed cardiac mechanical activity information in response to the pacing at the first interventricular septal site.

A system for pacing a cardiac conduction system of a heart, the system comprising:

• an electrostimulation circuit configured to generate stimulation energy to pace the heart;
• a sensing circuit configured to sense a far-field ventricular activity;
• and
• a control circuit, configured to:
• generate a control signal to the electrostimulation circuit to pace the cardiac conduction system at a first interventricular septal site of the heart;
• determine a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity in response to pacing at the first interventricular septal site;
• and
• verify a capture status as a capture or a loss of capture (LOC) using the determined cardiac synchrony indicator, and in response to the LOC, control the electrostimulation circuit to pace the cardiac conduction system at a second interventricular septal site of the heart different than the first interventricular septal site,
• wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the pacing at the first interventricular septal site,
• wherein the control circuit is configured to:
• determine the cardiac synchrony indicator based on a change or a rate of change in QRS width over time from the far-field electrogram;
• and
• verify the capture of the cardiac conduction system when the change or the rate of change in QRS width is above or equal to a threshold, and the LOC of the cardiac conduction system when the change or the rate of change in QRS width is below the threshold.

A method of pacing a cardiac conduction system of a heart using a cardiac pacing system, the method comprising:

• electrically stimulating the cardiac conduction system including an interventricular septum of the heart;
• sensing a far-field ventricular activity in response to the stimulation of the cardiac conduction system;
• determining a cardiac synchrony indicator based at least in part on the sensed far-field ventricular activity;
• and
• verifying a capture status as a capture or a loss of capture (LOC) using the determined cardiac synchrony indicator,
• wherein the sensed far-field ventricular activity includes a far-field electrogram in response to the stimulation of the cardiac conduction system,
• wherein determining the cardiac synchrony indicator includes determining a change or a rate of change in QRS width over time from the far-field electrogram,
• wherein verifying the capture status includes verifying the capture of the cardiac conduction system when the change or the rate of change in QRS width is above or equal to a threshold, and verifying the LOC of the cardiac conduction system when the change or the rate of change in QRS width is below the threshold.