# US 2019/0167994 A1 · Latency-based adaptation of anti-tachyarrhythmia pacing therapy > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 2019/0167994 A1 - Document ID: US20190167994A1 - Status: Published application - Kind: A1 - Application number: 16/268,941 - Filed: 2019-02-06 - Published: 2019-06-06 - Earliest claimed: 2016-04-28 - Assignees: Medtronic, Inc. - Applicants: Medtronic, Inc. - Inventors: Troy E. Jackson; Vincent P. Ganion - Web page: https://patentgrep.com/patent/US20190167994A1 ## CPC - A61N 1/3622: {comprising two or more electrodes co-operating with different heart regions} - A61N 1/05: for implantation or insertion into the body, e.g. heart electrode (A61N1/06 takes precedence) - A61N 1/056: {Transvascular endocardial electrode systems} - A61N 1/3621: {for treating or preventing abnormally high heart rate} - A61N 1/3712: {Auto-capture, i.e. automatic adjustment of the stimulation threshold} - A61N 1/3756: {Casings with electrodes thereon, e.g. leadless stimulators} - A61N 1/3962: {in combination with another heart therapy} - 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 comprises therapy delivery circuitry and processing circuitry. The therapy delivery circuitry is configured to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient. The ATP therapy includes one or more pulse trains and each of the one or more pulse trains includes a plurality of pacing pulses. The processing circuitry is configured to, for at least one of the plurality of pacing pulses of at least one of the one or more pulse trains, determine at least one latency metric of an evoked response of the heart to the pacing pulse. The processing circuitry is further configured to modify the ATP therapy based on the at least one latency metric. ## Claims ### Claim at position 1 1: A method comprising: delivering anti-tachycardia pacing (ATP) therapy to a heart of a patient according to ATP parameters that define a sequence for delivery of a plurality of pacing pulses as one or more pulse trains, the sequence configured to terminate a tachyarrhythmia, each of the one or more pulse trains comprising one or more of the plurality of pacing pulses, the ATP therapy including at least a first pulse train of the one or more pulse trains; for at least one or more pacing pulses of the first pulse train, determining at least one latency metric of an evoked response of the heart to the one or more pacing pulses of the first pulse train; and modifying the ATP therapy based on the at least one latency metric. ### Claim at position 2 (depends on 1) 2: The method of claim 1, wherein determining the at least one latency metric comprises determining at least one morphological metric of the evoked response. ### Claim at position 3 (depends on 1) 3: The method of claim 1, wherein determining the at least one latency metric comprises determining an interval between the one or more pacing pulses of the first pulse train and the evoked response. ### Claim at position 4 (depends on 1) 4: The method of claim 1, wherein the sequence comprises a series of cycle lengths for the plurality of pacing pulses configured to terminate the tachyarrhythmia. ### Claim at position 5 (depends on 1) 5: The method of claim 1, wherein the one or more pulse trains comprise a plurality of pulse trains, and wherein modifying the ATP therapy comprises modifying at least one of the ATP parameters that define a subsequent pulse train prior to delivery of the subsequent pulse train. ### Claim at position 6 (depends on 1) 6: The method of claim 1, wherein delivering the ATP therapy comprises delivering the first pulse train to a first location of the heart, the method further comprising: comparing the at least one latency metric to a threshold; and determining that a latency metric of the at least one latency metric satisfies the threshold, wherein modifying the ATP therapy based on the at least one latency metric comprises delivering a subsequent pulse train of the one or more pulse trains to a second location of the heart based on determining that the latency metric of the at least one latency metric satisfies the threshold. ### Claim at position 7 (depends on 5) 7: The method of claim 5, wherein modifying the at least one of the ATP parameters that define the subsequent pulse train comprises modifying a common cycle length of the one or more pacing pulses of the subsequent pulse train prior to delivery of the one or more pacing pulses of the subsequent pulse train. ### Claim at position 8 (depends on 5) 8: The method of claim 5, wherein the ATP parameters that define the subsequent pulse train include a cycle length of one or more of a plurality of pacing pulses of the subsequent pulse train, and wherein modifying the at least one of the ATP parameters that define the subsequent pulse train comprises increasing the cycle length of the one or more of the plurality of pacing pulses of the subsequent pulse train. ### Claim at position 9 (depends on 8) 9: The method of claim 8, wherein increasing the cycle length of the one or more of the plurality of pacing pulses of the subsequent pulse train comprises increasing the cycle length from a first value that is less than a corresponding cycle length of one or more pacing pulses of the first pulse train to a second value that is greater than the corresponding cycle length of the one or more pacing pulses of the first pulse train. ### Claim at position 10 (depends on 5) 10: The method of claim 5, wherein the ATP parameters that define the at least one first pulse train and the subsequent pulse train comprise at least one ATP parameter that specifies a pacing vector for delivery of the at least one first pulse train and the subsequent pulse train, and wherein modifying the at least one of the ATP parameters that define the subsequent pulse train comprises specifying a different pacing vector for delivery of the subsequent pulse train. ### Claim at position 11 (depends on 5) 11: The method of claim 5, wherein the one or more pacing pulses of the subsequent pulse train comprise a plurality of pacing pulses, wherein the ATP parameters define a first phase comprising one or more first pacing pulses of the plurality of pacing pulses, the one or more first pacing pulses having a first cycle length, and a second phase comprising one or more second pacing pulses of the plurality of pacing pulses, the one or more second pacing pulses having a second cycle length that is less than the first cycle length, wherein modifying the subsequent pulse train comprises modifying the ATP parameters that define the subsequent pulse train comprises at least one of: adding one or more pacing pulses having the first cycle length to the first phase, adding one or more pacing pulses having the second cycle length to the second phase, or adding an intermediate phase comprising one or more pulses between the first phase and the second phase, a cycle length of the one or more pacing pulses of the intermediate phase being between the first cycle length and the second cycle length. ### Claim at position 12 (depends on 1) 12: The method of claim 1, wherein modifying the ATP therapy comprises modifying at least one of the ATP parameters that defines the first pulse train. ### Claim at position 13 (depends on 12) 13: The method of claim 12, wherein modifying the at least one of the ATP parameters that define the first pulse train comprises modifying a common cycle length of the one or more pacing pulses of first pulse train prior to delivery of the one or more pacing pulses of the first pulse train. ### Claim at position 14 (depends on 12) 14: The method of claim 12, wherein the one or more pacing pulses of the first pulse train comprise a plurality of pacing pulses, wherein the ATP parameters define a first phase comprising one or more first pacing pulses of the plurality of pacing pulses, the one or more first pacing pulses having a first cycle length, and a second phase comprising one or more second pacing pulses of the plurality of pacing pulses, the one or more second pacing pulses having a second cycle length that is less than the first cycle length, and wherein modifying the first pulse train comprises modifying the ATP parameters that define the first pulse train comprises at least one of: adding one or more pacing pulses having the first cycle length to the first phase, adding one or more pacing pulses having the second cycle length to the second phase, or adding an intermediate phase comprising one or more pulses between the first phase and the second phase, a cycle length of the one or more pacing pulses of the intermediate phase being between the first cycle length and the second cycle length. ### Claim at position 15 (depends on 14) 15: The method of claim 14, wherein each of the one or more pulse trains defines one or more phases, wherein each of the one or more phases includes at least one of the one or more pacing pulses having a common cycle length corresponding to the phase, and wherein modifying the first pulse train comprises advancing to a next one of the one or more phases based on the at least one latency metric. ### Claim at position 16 (depends on 15) 16: The method of claim 15, wherein advancing to the next one of the phases comprises advancing to the next one of the phases in response to at least one of: a latency metric of the at least one latency metric not satisfying a threshold, or a difference between the latency metric and a previous latency metric of a previous pulse of the one or more pulse trains not satisfying a latency metric difference threshold. ### Claim at position 17 (depends on 1) 17: The method of claim 1, wherein delivering the ATP therapy comprises delivering the one or more pacing pulses of the first pulse train to a first location of the heart; wherein determining the at least one latency metric of the evoked response of the heart to the one or more pacing pulses of the first pulse train comprises at least one of: determining a local latency metric based on sensing the evoked response at one of the first location or a second location of the heart, or determining a large-scale latency metric based on sensing the evoked response at a third location, wherein the third location is located further from the first location than the second location. ### Claim at position 18 (depends on 17) 18: The method of claim 17, wherein determining the local latency metric comprises at least one of: determining an interval between a pacing pulse of the one or more pacing pulses of the first pulse train and the evoked response at the one of the first location or a second location, and determining at least one morphological metric of the evoked response at the one of the first location or a second location, and determining the large-scale latency metric comprises at least one of: determining an interval between the pacing pulse of the one or more pacing pulses of the first pulse train and the evoked response at the third location, and determining at least one morphological metric of the evoked response at third location. ### Claim at position 19 19: A medical device comprising: therapy delivery circuitry configured to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient; and processing circuitry configured to: control the therapy delivery circuitry to deliver ATP therapy to the heart of the patient according to ATP parameters that define a sequence for delivery of a plurality of pacing pulses as one or more pulse trains, the sequence configured to terminate a tachyarrhythmia, each of the one or more pulse trains comprising one or more of the plurality of pacing pulses, the ATP therapy including at least a first pulse train of the one or more pulse trains; for at least one or more pacing pulses of the first pulse train, determine at least one latency metric of an evoked response of the heart to the one or more pacing pulses of the first pulse train; and modify the ATP therapy based on the at least one latency metric. ### Claim at position 20 (depends on 19) 20: The medical device of claim 19, wherein the processing circuitry is configured to determine the at least one latency metric by at least determining at least one morphological metric of the evoked response. ### Claim at position 21 (depends on 19) 21: The medical device of claim 19, wherein the processing circuitry is configured to determine the at least one latency metric by at least determining an interval between the one or more pacing pulses of the first pulse train and the evoked response. ### Claim at position 22 (depends on 19) 22: The medical device of claim 19, wherein the sequence comprises a series of cycle lengths for the plurality of pacing pulses configured to terminate the tachyarrhythmia. ### Claim at position 23 (depends on 19) 23: The medical device of claim 19, wherein the one or more pulse trains comprise a plurality of pulse trains, and wherein the processing circuitry is configured to modify the ATP therapy by at least modifying at least one of the ATP parameters that define a subsequent pulse train prior to delivery of the subsequent pulse train. ### Claim at position 24 (depends on 19) 24: The medical device of claim 19, wherein the processing circuitry is configured to control the therapy delivery circuitry to deliver the ATP therapy by at least controlling the therapy delivery circuitry to deliver the first pulse train to a first location of the heart, wherein the processing circuitry is further configured to: compare the at least one latency metric to a threshold; and determine that a latency metric of the at least one latency metric satisfies the threshold, wherein the processing circuitry is configured to modify the ATP therapy based on the at least one latency metric by at least controlling the therapy delivery circuitry to deliver a subsequent pulse train of the one or more pulse trains to a second location of the heart based on determining that the latency metric of the at least one latency metric satisfies the threshold. ### Claim at position 25 (depends on 23) 25: The medical device of claim 23, wherein the processing circuitry is configured to modify the at least one of the ATP parameters that define the subsequent pulse train comprises by at least modifying a common cycle length of the one or more pacing pulses of the subsequent pulse train prior to delivery of the one or more pacing pulses of the subsequent pulse train. ### Claim at position 26 (depends on 23) 26: The medical device of claim 23, wherein the ATP parameters that define the subsequent pulse train include a cycle length of one or more of a plurality of pacing pulses of the subsequent pulse train, and wherein the processing circuitry is configured to modify the at least one of the ATP parameters that define the subsequent pulse train by at least increasing the cycle length of the one or more of the plurality of pacing pulses of the subsequent pulse train. ### Claim at position 27 (depends on 26) 27: The medical device of claim 26, wherein the processing circuitry is configured to increase the cycle length of the one or more of the plurality of pacing pulses of the subsequent pulse train by at least increasing the cycle length from a first value that is less than a corresponding cycle length of one or more pacing pulses of the first pulse train to a second value that is greater than the corresponding cycle length of the one or more pacing pulses of the first pulse train. ### Claim at position 28 (depends on 23) 28: The medical device of claim 23, wherein the ATP parameters that define the at least one first pulse train and the subsequent pulse train comprise at least one ATP parameter that specifies a pacing vector for delivery of the at least one first pulse train and the subsequent pulse train, and wherein the processing circuitry is configured to modify the at least one of the ATP parameters that define the subsequent pulse train by at least specifying a different pacing vector for delivery of the subsequent pulse train. ### Claim at position 29 (depends on 23) 29: The medical device of claim 23, wherein the one or more pacing pulses of the subsequent pulse train comprise a plurality of pacing pulses, wherein the ATP parameters define a first phase comprising one or more first pacing pulses of the plurality of pacing pulses, the one or more first pacing pulses having a first cycle length, and a second phase comprising one or more second pacing pulses of the plurality of pacing pulses, the one or more second pacing pulses having a second cycle length that is less than the first cycle length, wherein the processing circuitry is configured to modify the subsequent pulse train by at least modifying the ATP parameters that define the subsequent pulse train by at least one of: adding one or more pacing pulses having the first cycle length to the first phase, adding one or more pacing pulses having the second cycle length to the second phase, or adding an intermediate phase comprising one or more pulses between the first phase and the second phase, a cycle length of the one or more pacing pulses of the intermediate phase being between the first cycle length and the second cycle length. ### Claim at position 30 (depends on 19) 30: The medical device of claim 19, wherein the processing circuitry is configured to modify the ATP therapy by at least modifying at least one of the ATP parameters that defines the first pulse train. ### Claim at position 31 (depends on 30) 31: The medical device of claim 30, wherein the processing circuitry is configured to modify the at least one of the ATP parameters that define the first pulse train by at least modifying a common cycle length of the one or more pacing pulses of first pulse train prior to delivery of the one or more pacing pulses of the first pulse train. ### Claim at position 32 (depends on 30) 32: The medical device of claim 30, wherein the one or more pacing pulses of the first pulse train comprise a plurality of pacing pulses, wherein the ATP parameters define a first phase comprising one or more first pacing pulses of the plurality of pacing pulses, the one or more first pacing pulses having a first cycle length, and a second phase comprising one or more second pacing pulses of the plurality of pacing pulses, the one or more second pacing pulses having a second cycle length that is less than the first cycle length, and wherein the processing circuitry is configured to modify the first pulse train by at least modifying the ATP parameters that define the first pulse train by at least one of: adding one or more pacing pulses having the first cycle length to the first phase, adding one or more pacing pulses having the second cycle length to the second phase, or adding an intermediate phase comprising one or more pulses between the first phase and the second phase, a cycle length of the one or more pacing pulses of the intermediate phase being between the first cycle length and the second cycle length. ### Claim at position 33 (depends on 32) 33: The medical device of claim 32, wherein each of the one or more pulse trains defines one or more phases, wherein each of the one or more phases includes at least one of the one or more pacing pulses having a common cycle length corresponding to the phase, and wherein the processing circuitry is configured to modify the first pulse train by at least advancing to a next one of the one or more phases based on the at least one latency metric. ### Claim at position 34 (depends on 33) 34: The medical device of claim 33, wherein the processing circuitry is configured to advance to the next one of the phases by at least advancing to the next one of the phases in response to at least one of: a latency metric of the at least one latency metric not satisfying a threshold, or a difference between the latency metric and a previous latency metric of a previous pulse of the one or more pulse trains not satisfying a latency metric difference threshold. ### Claim at position 35 (depends on 19) 35: The medical device of claim 19, wherein the processing circuitry is configured to control the therapy delivery circuitry to deliver the ATP therapy by at least controlling the therapy delivery circuitry to deliver the one or more pacing pulses of the first pulse train to a first location of the heart; wherein the processing circuitry is configured to determine the at least one latency metric of the evoked response of the heart to the one or more pacing pulses of the first pulse train by at least one of: determining a local latency metric based on sensing the evoked response at one of the first location or a second location of the heart, or determining a large-scale latency metric based on sensing the evoked response at a third location, wherein the third location is located further from the first location than the second location. ### Claim at position 36 (depends on 35) 36: The medical device of claim 35, wherein the processing circuitry is configured to determine the local latency metric by at least one of: determining an interval between a pacing pulse of the one or more pacing pulses of the first pulse train and the evoked response at the one of the first location or a second location, and determining at least one morphological metric of the evoked response at the one of the first location or a second location, and determining the large-scale latency metric comprises at least one of: determining an interval between the pacing pulse of the one or more pacing pulses of the first pulse train and the evoked response at the third location, and determining at least one morphological metric of the evoked response at third location. ### Claim at position 37 37: A non-transitory computer-readable medium storing instructions for causing processing circuitry to perform a method comprising: controlling therapy delivery circuitry to deliver anti-tachycardia pacing (ATP) therapy to a heart of a patient according to ATP parameters that define a sequence for delivery of a plurality of pacing pulses as one or more pulse trains, the sequence configured to terminate a tachyarrhythmia, each of the one or more pulse trains comprising one or more of the plurality of pacing pulses, the ATP therapy including at least a first pulse train of the one or more pulse trains; for at least one or more pacing pulses of the first pulse train, determining at least one latency metric of an evoked response of the heart to the one or more pacing pulses of the first pulse train; and modifying the ATP therapy based on the at least one latency metric. ### Claim at position 38 (depends on 37) 38: The non-transitory computer-readable medium of claim 37, wherein the instructions cause the processing circuitry to control the therapy delivery circuitry to deliver the ATP therapy by at least controlling the therapy delivery circuitry to deliver the first pulse train to a first location of the heart, the method further comprising: comparing the at least one latency metric to a threshold; and determining that a latency metric of the at least one latency metric satisfies the threshold, wherein modifying the ATP therapy based on the at least one latency metric comprises delivering a subsequent pulse train of the one or more pulse trains to a second location of the heart based on determining that the latency metric of the at least one latency metric satisfies the threshold.