Systems and methods for optimizing ventricular pacing delays for use with multi-pole leads

A method for controlling ventricular pacing for use by an implantable cardiac rhythm management device equipped with a multi-pole ventricular lead having a plurality of electrodes, the method comprising:

• identifying an electrical event sufficient to trigger ventricular depolarization within the heart of a patient in which the device is implanted;
• detecting a resulting ventricular depolarization at each of a plurality of electrodes of the multi-pole lead, the depolarization being detected at generally different times at each different electrode;
• determining an interventricular conduction time delay for each of the plurality of electrodes of the multi-pole lead based on the depolarization triggered by the electrical event, the conduction time delay including at least one of a paced interventricular conduction time delay and an intrinsic interventricular conduction time delay;
• controlling ventricular pacing using a selected electrode of the multi-pole lead based, at least in part, on the interventricular conduction time delay determined for that electrode;
• wherein the multi-pole lead is a left ventricular (LV) lead having a plurality of electrodes (LVn) and the device is equipped with a right ventricular (RV) lead and wherein the method is performed to control ventricular pacing delivered between an RV electrode of the RV lead and a selected electrode (LVn) of the multi-pole LV lead;
• wherein detecting the resulting ventricular depolarization at each of a plurality of electrodes of the multi-pole lead includes detecting a resulting LV QRS complex (LVn QRS) at each of the plurality of LV electrodes (LVn) of the LV lead;
• detecting a resulting RV QRS complex at the RV electrode of the RV lead and wherein the interventricular conduction time delay to be determined for each of the plurality of electrodes of the lead includes an intrinsic interventricular conduction time delay (Δn) for each of the plurality of electrodes of the LV lead (LVn) based on the RV QRS and the LVn QRS complexes;
• wherein the electrical event sufficient to trigger ventricular depolarization is an intrinsic atrial depolarization (P-wave);
• determining an intrinsic atrioventricular time delay (PRLVn) between the P-wave and each of the plurality of LV electrodes;
• and
• wherein determining PRLVn for each of the plurality of LV electrodes is performed based on the PRRV time delay and the respective Δn delays.

A method for controlling ventricular pacing for use by an implantable cardiac rhythm management device equipped with a multi-pole ventricular lead having a plurality of electrodes, the method comprising:

• identifying an electrical event sufficient to trigger ventricular depolarization within the heart of a patient in which the device is implanted;
• detecting a resulting ventricular depolarization at each of a plurality of electrodes of the multi-pole lead, the depolarization being detected at generally different times at each different electrode;
• determining an interventricular conduction time delay for each of the plurality of electrodes of the multi-pole lead based on the depolarization triggered by the electrical event, the conduction time delay including at least one of a paced interventricular conduction time delay and an intrinsic interventricular conduction time delay;
• controlling ventricular pacing using a selected electrode of the multi-pole lead based, at least in part, on the interventricular conduction time delay determined for that electrode;
• wherein the multi-pole lead is a left ventricular (LV) lead having a plurality of electrodes (LVn) and the device is equipped with a right ventricular (RV) lead and wherein the method is performed to control ventricular pacing delivered between an RV electrode of the RV lead and a selected electrode (LVn) of the multi-pole LV lead;
• wherein detecting the resulting ventricular depolarization at each of a plurality of electrodes of the multi-pole lead includes detecting a resulting LV QRS complex (LVn QRS) at each of the plurality of LV electrodes (LVn) of the LV lead;
• and further comprising
• detecting a resulting RV QRS complex at the RV electrode of the RV lead and wherein the interventricular conduction time delay to be determined for each of the plurality of electrodes of the lead includes an intrinsic interventricular conduction time delay (Δn) for each of the plurality of electrodes of the LV lead (LVn) based on the RV QRS and the LVn QRS complexes;
• wherein the electrical event sufficient to trigger ventricular depolarization is an atrial pacing pulse (A-pulse);
• determining a paced atrioventricular time delay (ARLVn) between the initial A-pulse and each of the plurality of LV electrodes;
• and
• wherein determining paced atrioventricular conduction time delays (ARLVn) for each of the plurality of LV electrodes is performed based on the ARRV time delay and the respective Δn delays.