US 2026/0306853 A1Published application

Detection and verification methods and systems for left bundle branch pacing capture

OwnerMichael V Orlov, Zachary Whinnettinventors

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Abstract

Methods and systems for detecting and verifying left bundle branch pacing capture are disclosed. The invention provides objective, quantifiable criteria for differentiating left bundle branch capture from left ventricular septal capture by measuring the direction of electrical impulse propagation and time delays along the lateral wall of the left ventricle. A novel bidirectional pacing protocol measures conduction times in both anterograde and retrograde directions, exploiting the preferential anterograde conduction properties of the specialized His-Purkinje system. The resulting bidirectional conduction time differential (delta) provides a functional assessment of conduction system engagement, with a significant delta (20 milliseconds or greater) confirming left bundle branch capture. The invention enables real-time verification using noninvasive electrocardiographic imaging during septal electrode implantation, providing immediate visual feedback of ventricular activation patterns and enabling iterative optimization of lead position. Chronic monitoring methods detect late loss of left bundle branch capture with automated alerting and corrective actions.

Claims20

Dependent claims

A method for detecting a capture of a left bundle branch of a heart for pacing purposes, the method comprising the following steps:

(a) deploying a septal electrode configured for left bundle branch pacing in an interventricular septum of a heart at a location intended for left bundle branch pacing,
(b) monitoring a direction of electrical impulse propagation along a lateral wall during left ventricle activation and measuring a time delay from an electrical activation of the interventricular septum to an electrical activation of the lateral wall,
(c) initiating cardiac pacing using the septal electrode of step (a),
(d) for patients with abnormal direction of electrical impulse propagation along the lateral wall of the left ventricle at baseline, identifying left bundle branch capture upon detecting:
a restoration or change toward a physiologically normal apex-to-base direction of electrical impulse propagation along the lateral wall after initiation of cardiac pacing in step (c), OR a shortening of the time delay from electrical activation of the interventricular septum to electrical activation of the lateral wall by at least 15% compared to baseline, thereby indicating restoration of rapid conduction via the specialized conduction system,
(e) for patients with abnormal direction of electrical impulse propagation along the lateral wall at baseline, identifying left ventricular septal capture (absent left bundle branch capture) upon detecting:
persistence or worsening of abnormal electrical impulse propagation direction after initiation of cardiac pacing in step (c), OR persistence of prolonged time delay from electrical activation of the interventricular septum to electrical activation of the lateral wall, wherein the time delay remains within 15% of the baseline delay or increases, thereby indicating absence of rapid conduction via the specialized conduction system and/or loss of normal apex-to-base activation pattern.

4 more elements

A method for differentiating between a left ventricular septal capture and a left bundle branch capture during heart pacing, the method comprising:

(a) deploying a septal electrode configured for left bundle branch pacing in an interventricular septum of a heart at a location intended for left bundle branch pacing,
(b) deploying at least two lateral wall electrodes along a lateral wall of a left ventricle, wherein the at least two lateral wall electrodes are spaced apart along a direction between an apex and a base of the heart,
(c) initiating a first pacing protocol by pacing from the septal electrode and measuring a first conduction time from a pacing stimulus delivered by the septal electrode to electrical activation detected at the at least two lateral wall electrodes,
(d) initiating a second pacing protocol by pacing from at least one of the at least two lateral wall electrodes and measuring a second conduction time from a pacing stimulus delivered by said at least one lateral wall electrode to electrical activation detected at the septal electrode,
(e) calculating a bidirectional conduction time differential (delta) as an absolute difference between the first conduction time and the second conduction time,
(f) identifying left bundle branch capture when the bidirectional conduction time differential exceeds a threshold value, wherein:
the first conduction time is shorter than the second conduction time, indicating rapid anterograde conduction through the specialized left bundle branch conduction system when pacing from the septal electrode, and slower retrograde myocardial conduction when pacing from the lateral wall electrodes, and the threshold value is selected from the range of 10 milliseconds to 50 milliseconds, preferably 15 milliseconds to 35 milliseconds, most preferably 20milliseconds to 30 milliseconds,
(g) identifying left ventricular septal capture when the bidirectional conduction time differential is less than the threshold value, indicating comparable slow myocardial conduction in both pacing directions and absence of specialized conduction system engagement.

5 more elements

A system for detecting left bundle branch capture comprising:

(a) a septal electrode configured for deployment in an interventricular septum and delivery of pacing stimuli,
(b) at least two lateral wall electrodes configured for deployment along a lateral wall of a left ventricle and spaced apart along a direction between an apex and a base of the heart, wherein the at least two lateral wall electrodes are configured to sense electrical activation of the lateral wall,
(c) a pacing module configured to:
deliver pacing stimuli from the septal electrode at adjustable pacing outputs, deliver pacing stimuli from the at least two lateral wall electrodes,
(d) a sensing module configured to:
receive electrical activation signals from the at least two lateral wall electrodes when pacing from the septal electrode, receive electrical activation signals from the septal electrode when pacing from the at least two lateral wall electrodes,
(e) a processing module configured to:
determine a sequence of electrical activation among the at least two lateral wall electrodes to identify a direction of electrical impulse propagation, measure a first conduction time from pacing stimuli delivered by the septal electrode to electrical activation detected at the at least two lateral wall electrodes, measure a second conduction time from pacing stimuli delivered by the at least two lateral wall electrodes to electrical activation detected at the septal electrode, calculate a bidirectional conduction time differential as an absolute difference between the first conduction time and the second conduction time, compare the bidirectional conduction time differential to a threshold value,
(f) an output module configured to:
indicate left bundle branch capture when the bidirectional conduction time differential exceeds the threshold value and the direction of electrical impulse propagation is apex-to-base, indicate left ventricular septal capture when the bidirectional conduction time differential is less than the threshold value or the direction of electrical impulse propagation is non-apex-to-base.

7 more elements

A method of real-time verification of left bundle branch capture during septal electrode implantation, comprising:

(a) deploying an electrocardiographic imaging (ECGi) system comprising a plurality of body surface electrodes prior to or during the implantation procedure,
(b) acquiring a three-dimensional cardiac geometry from computed tomography or magnetic resonance imaging, or using an artificial intelligence-derived geometric model,
(c) continuously recording electrical signals from the plurality of body surface electrodes during the implantation procedure,
(d) generating real-time or near-real-time activation maps showing ventricular electrical activation patterns as the septal electrode is advanced into the interventricular septum,
(e) initiating test pacing from the septal electrode at multiple depths of septal penetration and generating corresponding activation maps for each pacing maneuver,
(f) comparing the activation maps obtained at different septal depths to identify a transition from:
a left ventricular septal pacing pattern characterized by lateral left ventricular activation occurring with delayed timing and abnormal activation sequence, to a left bundle branch pacing pattern characterized by early septal activation followed by rapid and synchronous left ventricular lateral wall activation with restoration of physiological apex-to-base activation and shortened left ventricular activation time,
(g) confirming successful left bundle branch capture when the activation map demonstrates the left bundle branch pacing pattern and left ventricular activation time is shortened by at least 15% compared to baseline or compared to more superficial septal pacing sites,
(h) securing the septal electrode at the depth corresponding to confirmed left bundle branch capture.

6 more elements

Dependencies are inferred from the claim text.

Facts

Application: 19/460,062Filed 26 Jan 2026
Priority: 24 Jan 2025
Published: 8 Oct 2026
Term ends: Not estimatedThe source records don’t support an estimate.

Classification4 codes

A61N 1/3712
Capture, i.e. successful stimulation: auto-capture, i.e. automatic adjustment of the stimulation threshold
A61N 1/025
Details: digital circuitry features of electrotherapy devices, e.g. memory, clocks, processors
A61N 1/36842
For stimulating the heart at multiple sites of the ventricle or the atrium: multi-site stimulation in the same chamber
A61N
Electrotherapy