Method and system for improved estimation of time of left ventricular pacing with respect to intrinsic right ventricular activation in cardiac resynchronization therapy

A system of cardiac pacing comprising:

• a) processing means for determining a baseline rhythm, the baseline rhythm includes a baseline atrial event and a baseline right ventricular (RV) event from an implanted cardiac lead or a leadless device, a pre-excitation interval determined from the baseline atrial event and the baseline RV event, and a plurality of activation times determined from the plurality of body-surface electrodes;
• b) processing means for determining whether a time interval measured from an atrial event to a RV event is disparate from another time interval measured from the atrial event to an earliest RV activation time of the plurality of activation times;
• c) processing means for applying a correction factor to the pre-excitation interval to obtain a corrected pre-excitation interval in response to determining the RV event is disparate from the earliest RV activation time;
• and
• d) processing means for configuring the processor to signal the pulse generator to deliver electrical stimuli to a left ventricle (LV) using the corrected pre-excitation interval before the RV sensing time.

A system of cardiac pacing comprising:

• a) processing means for determining a baseline rhythm, the baseline rhythm includes a baseline atrial event and a baseline right ventricular (RV) event from an implanted cardiac lead or a leadless device, a pre-excitation interval determined from the baseline atrial event and the baseline RV event, and a plurality of activation times determined from the plurality of body-surface electrodes;
• b) processing means for determining whether a time interval measured from an atrial event to a RV event is disparate from another time interval measured from the atrial event to an earliest RV activation time of the plurality of activation times;
• c) processing means for applying a correction factor to the pre-excitation interval to obtain a corrected pre-excitation interval in response to determining the RV event is disparate from the earliest RV activation time;
• and
• d) processing means for configuring the processor to signal the pulse generator to deliver electrical stimuli to a left ventricle (LV) using the corrected pre-excitation interval before the RV sensing time, wherein disparate is defined as the earliest RV activation time which is about 40-300 ms ahead of the earliest sensed RV event.

A system of cardiac pacing comprising:

• a) processing means for determining a baseline rhythm, the baseline rhythm includes a baseline atrial event and a baseline right ventricular (RV) event from an implanted cardiac lead or a leadless device, a pre-excitation interval determined from the baseline atrial event and the baseline RV event, and a plurality of activation times determined from the plurality of body-surface electrodes;
• b) processing means for determining whether a time interval measured from an atrial event to a RV event is disparate from another time interval measured from the atrial event to an earliest RV activation time of the plurality of activation times;
• c) processing means for applying a correction factor to the pre-excitation interval to obtain a corrected pre-excitation interval in response to determining the RV event is disparate from the earliest RV activation time;
• and
• d) processing means for configuring the processor to signal the pulse generator to deliver electrical stimuli to a left ventricle (LV) using the corrected pre-excitation interval before the RV sensing time, wherein disparate is defined as the earliest RV activation time which is about 40-300 ms ahead of the earliest sensed RV event, wherein each of the plurality of activation times are determined by a timing of a steepest negative slope on the unipolar ECG signal from each of a plurality of surface electrodes and a common fiducial point,
• wherein the common fiducial point is the onset of depolarization (Q-point) measured from a surface ECG electrode or timing of an atrial event as sensed by an implantable medical device.