Local and non-local sensing for cardiac pacing

A method for delivery of pacing therapy, comprising:

• sensing, using body-implantable electrodes, at least one local cardiac electrical signal and at least one non-local cardiac electrical signal;
• sensing for a feature of the local signal corresponding to activation of a heart chamber;
• sensing for a feature of the non-local signal corresponding to activation of the heart chamber;
• and
• timing delivery of one or more pacing pulses based on a temporal relationship between timing of the feature of the local signal and timing of the feature of the non-local signal;
• wherein the body-implantable electrodes include a first electrode positioned in or on an implantable housing or header and a second electrode positioned in or on the implantable housing or header, the first and second electrodes being used for sensing for the feature of the non-local signal;
• and
• wherein timing the delivery of the pacing pulses comprises:
• triggering delivery of a pacing pulse based on the non-local feature if the non-local feature is detected;
• and
• triggering delivery of the pacing pulse based on the local feature if the non-local feature is not detected.

An implantable cardiac rhythm management device, comprising:

• a patient-internal medical device (PIMD) including a pulse generator disposed in a patient-implantable housing that may be provided with a header;
• a plurality of implantable electrodes coupled to the housing and configured to electrically couple to a heart, at least a first pair of the plurality of electrodes configured to sense a local cardiac signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber and at least a second pair of the plurality of electrodes configured to sense a non-local cardiac signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the second pair of electrodes including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header;
• sense circuitry coupled to the first and second electrode pairs and configured to sense the local cardiac signal via the first electrode pair and the non-local cardiac signal via the second electrode pair;
• detection circuitry configured to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber;
• and
• a control processor configured to time delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature;
• wherein the device is configured to operate on a beat-by-beat basis, such that the control processor is configured to deliver a given one of the one or more pacing pulses during a same cardiac beat in which the sense circuitry senses the local cardiac signal and the non-local cardiac signal.

An implantable cardiac rhythm management device, comprising:

• a plurality of implantable electrodes configured to electrically couple to a heart, the plurality of implantable electrodes including at least a first pair of electrodes and a second pair of electrodes;
• sense circuitry coupled to the first and second electrode pairs and configured to sense a local cardiac signal via the first electrode pair and a non-local cardiac signal via the second electrode pair;
• detection circuitry configured to detect a feature of the local signal associated with activation of a heart chamber and to detect a feature of the non-local signal associated with activation of the heart chamber;
• and
• a control processor configured to time delivery of one or more pacing pulses based on a temporal relationship between timing of the local signal feature and timing of the non-local signal feature;
• wherein the control processor is configured to trigger pacing based on the timing of the non-local signal feature if the non-local signal feature is detected and to trigger pacing based on the timing of the local signal feature if the non-local signal feature is not detected.

A system for delivery of pacing therapy to a heart, comprising:

• a patient-internal medical device (PIMD) including a pulse generator disposed in a patient-implantable housing that may be provided with a header;
• a first pair of body-implantable electrodes coupled to the housing and configured to sense a local cardiac signal predominantly indicating cardiac electrical activity close to a local site within a heart chamber;
• a second pair of body-implantable electrodes coupled to the housing and configured to sense a non-local cardiac signal comprising a superposition of cardiac electrical signals occurring within the heart and associated with a cardiac contraction, the second pair of electrodes including a first electrode positioned in or on the housing or header and a second electrode positioned in or on the housing or header;
• means for detecting a feature of the local signal related to activation of a cardiac chamber;
• means for detecting a feature of the non-local signal related to activation of the cardiac chamber and including information about activation of a plurality of heart chambers;
• and
• means for timing delivery of one or more pacing pulses based on a temporal relationship between timing of the local feature and timing of the non-local feature;
• wherein the device is configured to operate on a beat-by-beat basis, such that the timing means is configured to deliver a given one of the one or more pacing pulses during a same cardiac beat in which the first and second pairs of body-implantable electrodes sense the local and non-local cardiac signals respectively.