Multi-site crt capture verification

An automated method of operation of a medical device system, the method comprising:

• sensing an intrinsic cardiac activation using a plurality of implantable electrodes disposed at three or more locations within a subject's body;
• determining a baseline intrinsic activation vector according to the sensed intrinsic cardiac activation, wherein an intrinsic activation vector includes direction information of propagation of activation of cardiac tissue;
• delivering electrical pacing therapy to the heart chamber using initial pacing parameters determined according to the baseline intrinsic activation vector;
• sensing a paced activation vector using the plurality of electrodes;
• and
• adjusting one or more pacing therapy parameters according to the paced activation vector.

An apparatus comprising:

• a cardiac signal sensing circuit configured for coupling to a plurality of electrodes and configured to sense a cardiac activation signal at each of three or more locations within a heart chamber of a subject;
• a stimulus circuit configured for coupling to the plurality of electrodes and configured to provide electrical pacing stimulation energy to the electrodes;
• a signal processing circuit electrically coupled to the cardiac signal sensing circuit and configured to determine an activation vector according to the sensed cardiac activation signals, wherein an activation vector includes direction information of propagation of activation of cardiac tissue;
• and
• a control circuit electrically coupled to the cardiac signal sensing circuit and stimulus circuit and configured to:
• initiate delivery of pacing pulses using combinations of the electrodes, wherein the combinations include using each of the electrodes of the plurality of electrodes and combinations of the electrodes as a pacing cathode and the other electrodes of the plurality of electrodes as the pacing anode;
• initiate sensing of paced activation vectors resulting from the pacing pulses;
• determine a cardiac capture pulse energy level threshold for the combinations of the electrodes using the sensed paced activation vectors;
• and
• select one or more electrodes of the plurality of electrodes for delivering subsequent electrical pacing therapy according to determined cardiac capture pulse energy level thresholds.