Cardiac rhythm management system with staggered pulses for coordination therapy

Abstract

A cardiac rhythm management system for coordination therapy includes a pulse generator to generate pacing and discharging of recharge pulses. A pulse delivery controller coupled to the pulse generator, times the delivery of the pacing and discharging of recharge pulses in a desired sequence. A therapy circuit coupled to the pulse delivery controller, receives the timed pulses from the pulse delivery controller and delivers the timed pulses to one or more electrodes disposed in or around a heart to communicate the timed pacing and discharging of recharge pulses to different sites of a heart, to avoid any interactions resulting from the electric fields surrounding the electrodes during a multiple site pacing required by the coordination therapy.

1 . An implantable cardiac rhythm management (CRM) device coupled to a first electrode and a second electrode, the implantable CRM device comprising: 
 a pulse delivery controller configured to issue control signals for delivering first and second pacing pulses and discharging recharge pulses each associated with the first and second pacing pulses such that the second pacing pulse is delivered after an end of the first pacing pulse and before a beginning of the discharging of the recharge pulses.    
   
   
       2 . The implantable CRM device of  claim 1 , wherein the pulse delivery controller is configured to issue control signals for delivering the first pacing pulse to the first electrode and for delivering the second pacing pulse to the second electrode.  
   
   
       3 . The implantable CRM device of  claim 1 , wherein the pulse delivery controller is configured to issue the control signals such that the first pacing pulse and the second pacing pulse are substantially simultaneous while non-overlapping.  
   
   
       4 . The implantable CRM device of  claim 2 , wherein the pulse delivery controller is configured to issue the control signals such that the beginning of the second pacing pulse is 2 to 10 milliseconds after the end of the first pacing pulse.  
   
   
       5 . The implantable CRM device of  claim 1 , wherein the pulse delivery controller is configured to generate an offset between the end of the first pacing pulse and the beginning of the second pacing pulse.  
   
   
       6 . The implantable CRM device of  claim 5 , wherein the pulse delivery controller is configured to generate the offset being a time interval between about 2 and 10 milliseconds.  
   
   
       7 . The implantable CRM device of  claim 6 , wherein the first pacing pulse is a right ventricular pacing pulse and the second pacing pulse is a left ventricular pacing pulse, and further comprising ventricular therapy circuits configured to deliver the right ventricular pacing pulse and the left ventricular pacing pulse.  
   
   
       8 . A method for controlling delivery of cardiac pacing pulses, the method comprising: 
 delivering a plurality of pacing pulses; and    discharging a plurality of recharge pulses each associated with one of the pacing pulses of the plurality of pacing pulses after the delivery of the plurality of pacing pulses is completed.    
   
   
       9 . The method of  claim 8 , wherein delivering the plurality of pacing pulses comprises: 
 delivering a first pacing pulse to a first electrode; and    delivering a second pacing pulse to a second electrode after an end of the first pacing pulse,    and wherein discharging the plurality of recharge pulses comprises discharging recharge pulses each associated with one of the first pacing pulse and the second pacing pulse after an end of the second pacing pulse.    
   
   
       10 . The method of  claim 9 , comprising timing a time offset between delivering the first pacing pulse and delivering the second pacing pulse.  
   
   
       11 . The method of  claim 10 , wherein timing the time offset comprises timing a time interval between the end of the first pacing pulse and a beginning of the second pacing pulse.  
   
   
       12 . The method of  claim 11 , wherein timing the time interval comprises timing a time interval between approximately 2 and 10 milliseconds.  
   
   
       13 . The method of  claim 12 , wherein delivering the first pacing pulse comprises delivering a right ventricular pacing pulse, and delivering the second pacing pulse comprises delivering a left ventricular pacing pulse.  
   
   
       14 . The method of  claim 12 , comprising delivering an atrial pacing pulse and discharging a recharge pulse associated with the atrial pacing pulse, and wherein delivering the right ventricular pacing pulse comprises delivering the right ventricular pacing pulse after an end of the recharge pulse associated with the atrial pacing pulse.  
   
   
       15 . A method for controlling delivery of cardiac pacing pulses, the method comprising: 
 delivering a plurality of pacing pulses to a plurality of electrodes, the pacing pulses are substantially simultaneous; and    discharging a plurality of recharge pulses each associated with one of the pacing pulses of the plurality of pacing pulses,    wherein each pulse of the plurality of pacing pulses and the plurality of recharge pulses is non-overlapping with another pulse of the plurality of pacing pulses and the plurality of recharge pulses.    
   
   
       16 . The method of  claim 15 , wherein discharging the plurality of recharge pulses comprises discharging the plurality of recharge pulses after the delivery of the plurality of pacing pulses is completed.  
   
   
       17 . The method of  claim 16 , wherein the delivering the plurality of pacing pulses comprises timing an offset between two pacing pulses of the plurality of pacing pulses.  
   
   
       18 . The method of  claim 17 , wherein timing the offset between the two pacing pulses comprises timing a time interval between an end of a first pacing pulse and a beginning of a subsequent second pacing pulse.  
   
   
       19 . The method of  claim 18 , wherein timing the time interval comprises timing a time interval between 2 and 10 milliseconds.  
   
   
       20 . The method of  claim 15 , wherein delivering the plurality of pacing pulses comprises delivering a plurality of ventricular pacing pulses.  
   
   
       21 . The method of  claim 20 , comprising delivering an atrial pacing pulse and discharging a recharge pulse associated with the atrial pacing pulse, and wherein delivering the plurality of ventricular pacing pulses comprises delivering the plurality of ventricular pacing pulses after an end of the recharge pulse associated with the atrial pacing pulse.