Methods for ventricular pacing

Abstract

An exemplary method includes determining an atrial to ventricular activation time for a right ventricle; determining an atrial to ventricular activation time for a left ventricle; and determining a pacing sequence that paces the right ventricle prior to activation of the left ventricle if the time for the right ventricle exceeds the time for the left ventricle or that paces the left ventricle prior to activation of the right ventricle if the time for the left ventricle exceeds the time for the right ventricle, wherein, in the pacing sequence, pacing of the prior, paced ventricle occurs at a time based at least in part on a difference between the time for the right ventricle and the time for the left ventricle and an atrio-ventricular delay limit. Various other exemplary methods, devices and/or systems are also disclosed.

1 . A method comprising: 
 determining an atrial to ventricular activation time for a right ventricle;    determining an atrial to ventricular activation time for a left ventricle; and    determining a pacing sequence that paces the right ventricle prior to activation of the left ventricle if the time for the right ventricle exceeds the time for the left ventricle or that paces the left ventricle prior to activation of the right ventricle if the time for the left ventricle exceeds the time for the right ventricle,    wherein, in the pacing sequence, pacing of the prior, paced ventricle occurs at a time based at least in part on a difference between the time for the right ventricle and the time for the left ventricle.    
   
   
       2 . The method of  claim 1 , further comprising updating the pacing sequence based on determining one or more updated atrial to ventricular activation times.  
   
   
       3 . The method of  claim 2 , wherein the updating comprises comparing the one or more updated atrial to ventricular activation times to one or more previously acquired atrial to ventricular activation times.  
   
   
       4 . The method of  claim 1 , wherein determining a pacing sequence comprises comparing one or more of the atrial to ventricular activation times to a limit.  
   
   
       5 . The method of  claim 4 , wherein comparing further comprises deciding if one of the atrial to ventricular activation times is normal or abnormal.  
   
   
       6 . The method of  claim 1 , wherein the determining a pacing sequence relies at least in part on an interventricular conduction delay.  
   
   
       7 . The method of  claim 1 , wherein the determining a pacing sequence relies at least in part on echocardiogram information.  
   
   
       8 . The method of  claim 1 , wherein the determining a pacing sequence relies at least in part on information acquired using an in vivo hemodynamic sensor.  
   
   
       9 . The method of  claim 1 , wherein the determining a pacing sequence relies at least in part on a predetermined atrio-ventricular delay.  
   
   
       10 . The method of  claim 1 , wherein the difference is an absolute value of the difference between the atrial to ventricular activation time for the right ventricle and the atrial to ventricular activation time for the left ventricle.  
   
   
       11 . The method of  claim 1 , wherein the pacing sequence includes pacing the latter activated ventricle to achieve a predetermined atrio-ventricular delay.  
   
   
       12 . An implantable device comprising: 
 means for determining an atrial to ventricular activation time for a right ventricle;    means for determining an atrial to ventricular activation time for a left ventricle; and    means for determining a pacing sequence that paces the right ventricle prior to activation of the left ventricle if the time for the right ventricle exceeds the time for the left ventricle or that paces the left ventricle prior to activation of the right ventricle if the time for the left ventricle exceeds the time for the right ventricle,    wherein, in the pacing sequence, pacing of the prior, paced ventricle occurs at a time based at least in part on a difference between the time for the right ventricle and the time for the left ventricle.    
   
   
       13 . The implantable device of  claim 12 , wherein means for determining a pacing sequence comprises means for comparing one or more of the atrial to ventricular activation times to the limit.  
   
   
       14 . The implantable device of  claim 13 , wherein the means for comparing includes control logic to decide if one of the atrial to ventricular activation times is normal or abnormal.  
   
   
       15 . An implantable device comprising: 
 a power supply;    a processor;    a lead including one or more electrodes capable of being positioned proximate to the right atrium;    a lead including one or more electrodes capable of being positioned proximate to a right ventricle;    a lead including one or more electrodes capable of being positioned proximate to a left ventricle; and    control logic, executable through use of the processor, to determine an atrial to ventricular activation time for a right ventricle using one or more of the leads, to determine an atrial to ventricular activation time for a left ventricle using one or more of the leads, and to determine a pacing sequence that paces the right ventricle using the lead capable of being positioned proximate to a right ventricle prior to activation of the left ventricle if the time for the right ventricle exceeds the time for the left ventricle or that paces the left ventricle using the lead capable of being positioned proximate to a left ventricle prior to activation of the right ventricle if the time for the left ventricle exceeds the time for the right ventricle,    wherein, in the pacing sequence, pacing of the prior, paced ventricle occurs at a time based at least in part on a difference between the time for the right ventricle and the time for the left ventricle.    
   
   
       16 . The implantable device of  claim 15 , wherein the control logic includes logic to compare one or more of the atrial to ventricular activation times to the limit.  
   
   
       17 . The implantable device of  claim 16 , wherein the control logic includes logic to decide if one of the atrial to ventricular activation times is normal or abnormal.  
   
   
       18 . The device of  claim 15 , wherein the pacing of the prior, paced ventricle occurs at a time based at least in part on an adjustment parameter.  
   
   
       19 . The device of  claim 18 , wherein the adjustment parameter depends on cardiac demand.  
   
   
       20 . A method comprising: 
 setting a pacing time for a right ventricle and setting a pacing time for a left ventricle;    pacing a heart using the pacing times;    sensing information germane to cardiac output;    based at least in part on the information, determining an optimal pacing time for one ventricle with respect to paced activation of the other ventricle; and    based at least in part on the optimal pacing time, determining an adjustment parameter value for use in a programmable implantable cardiac pacing device.    
   
   
       21 . The method of  claim 20 , further comprising changing demand on the heart and determining another adjustment parameter value.  
   
   
       22 . The method of  claim 21 , wherein the changing demand changes demand on the heart to a state selected from the group consisting of sleeping, resting, exercising or walking states.  
   
   
       23 . A method comprising: 
 setting one ventricle as a master ventricle and another ventricle as a slave ventricle wherein a stimulation sequence includes delivering stimulation to the master ventricle prior to delivering stimulation to the slave ventricle; and    wherein a time difference between the delivering stimulation to the master ventricle and the delivering stimulation to the slave ventricle is less than a master ventricle to slave ventricle paced interventricular conduction delay.    
   
   
       24 . The method of  claim 23 , wherein the time difference is less than a slave ventricle to master ventricle paced interventricular conduction delay.