Pacing and sensing vectors

Abstract

A method for allowing cardiac signals to be sensed and pacing pulse vectors to be delivered between two or more electrodes. In one embodiment, cardiac signals are sensed and pacing pulse vectors are delivered between at least one of a first left ventricular electrode and a second left ventricular electrode. Alternatively, cardiac signals are sensed and pacing pulse vectors are delivered between different combinations of the first and second left ventricular electrodes and a first supraventricular electrode. In addition, cardiac signals are sensed and pacing pulse vectors are delivered between different combinations of the first and second left ventricular electrode, the first supraventricular electrode and a conductive housing. In an additional embodiment, a first right ventricular electrode is used to sense cardiac signals and provide pacing pulses with different combinations of the first and second left ventricular electrodes, the first supraventricular electrode and the housing.

1 . (canceled) 
     
     
         2 . A system, comprising:
 a sensing circuit configured to sense cardiac signals;   a stimulation circuit configured to generate and deliver electrostimulation to a left ventricle of a heart; and   a control circuit coupled to the sensing circuit and the stimulation circuit, the control circuit configured to program a pacing vector for delivering the electrostimulation to the left ventricle of the heart;   wherein the control circuit is configured to alert the pacing vector based on the sensed cardiac signals.   
     
     
         3 . The system of  claim 2 , wherein:
 the sensed cardiac signals include an intrinsic cardiac activity; and   the control circuit is configured to select a first pacing vector if the intrinsic cardiac activity fails to satisfy a specified condition, or to select a second pacing vector if the intrinsic cardiac activity satisfies the specified condition.   
     
     
         4 . The system of  claim 2 , wherein:
 the sensed cardiac signals include an evoked cardiac activity sensed during the electrostimulation according to the pacing vector; and   the control circuit is configured to alter from a first pacing vector to a second pacing vector in response to the evoked cardiac activity satisfying a specified condition.   
     
     
         5 . The system of  claim 2 , comprising an implantable medical device that includes at least a portion of one or more of the sensing circuit, the stimulation circuit, or the control circuit. 
     
     
         6 . The system of  claim 4 , wherein:
 the first pacing vector includes a first anode and a first cathode each selected from two or more electrodes on a first lead adapted to be positioned at or near a left ventricle; or   the second pacing vector includes a second anode and a second cathode each selected from the two or more electrodes on the first lead.   
     
     
         7 . The system of  claim 4 , wherein:
 the first pacing vector includes a first cathode selected from two or more electrodes on a first lead adapted to be positioned at or near a left ventricle, and a first anode selected from one or more electrodes on a second lead adapted to be positioned at or near a region different from the left ventricle; or   the second pacing vector includes a second cathode selected from the two or more electrodes on the first lead, and a second anode selected from the one or more electrodes on the second lead.   
     
     
         8 . The system of  claim 7 , wherein the second lead is adapted to be positioned at one of a supraventricular region, a right atrium, or a right ventricle. 
     
     
         9 . The system of  claim 2 , wherein:
 the sensing circuit is configured to sense cardiac signals according to a first sensing vector that includes a first combination of electrodes each selected from two or more electrodes on a first lead or one or more electrodes on a second lead;   the control circuit, in response to the sensed cardiac signals satisfying a specified condition, is configured to:
 alter from the first sensing vector to a second sensing vector that includes a second combination of electrodes each selected from the two or more electrodes on the first lead or the one or more electrodes on the second lead, the second combination different from the first combination by at least one electrode; and 
 configure the sensing circuit to sense the cardiac signals according to the second sensing vector. 
   
     
     
         10 . The system of  claim 9 , wherein the first lead is adapted to be positioned at or near a left ventricle, and the second lead is adapted to be positioned at or near one of a supraventricular region, a right atrium, or a right ventricle. 
     
     
         11 . The system of  claim 10 , wherein the first or the second combination of electrodes includes a first electrode selected from the two or more electrodes on the first lead, and a second electrode selected from the one or more electrodes on the second lead. 
     
     
         12 . The system of  claim 10 , wherein the first or the second combination of electrodes includes first and second electrodes both selected from two or more electrodes on the second lead adapted to be positioned at the right ventricle. 
     
     
         13 . A method for providing electrostimulation to a heart using an implantable medical device, the method comprising:
 programming, using a programming device, a pacing vector for delivering electrostimulation to a left ventricle of a heart;   sensing cardiac signals with the implantable medical device; and   altering the pacing vector based on the sensed cardiac signals.   
     
     
         14 . The method of  claim 13 , wherein the sensed cardiac signals include an intrinsic cardiac activity, the method comprising:
 selecting a first pacing vector if the intrinsic cardiac activity fails to satisfy a specified condition; or   selecting a second pacing vector if the intrinsic cardiac activity satisfies the specified condition.   
     
     
         15 . The method of  claim 13 , wherein the sensed cardiac signals include an evoked cardiac activity sensed during the electrostimulation according to the pacing vector, and wherein altering the pacing vector includes altering from a first pacing vector to a second pacing vector in response to the evoked cardiac activity satisfying a specified condition. 
     
     
         16 . The method of  claim 15 , wherein:
 the first pacing vector includes a first anode and a first cathode each selected from two or more electrodes on a first lead adapted to be positioned at or near a left ventricle; or   the second pacing vector includes a second anode and a second cathode each selected from the two or more electrodes on the first lead.   
     
     
         17 . The method of  claim 15 , wherein:
 the first pacing vector includes a first cathode selected from two or more electrodes on a first lead adapted to be positioned at or near a left ventricle, and a first anode selected from one or more electrodes on a second lead adapted to be positioned at or near a region different from the left ventricle; or   the second pacing vector includes a second cathode selected from the two or more electrodes on the first lead, and a second anode selected from the one or more electrodes on the second lead.   
     
     
         18 . A method for providing electrostimulation to a heart using an implantable medical device, the method comprising:
 programming, using a programming device, a stimulation vector for delivering electrostimulation to a left ventricle of a heart and a sensing vector for sensing cardiac signals;   sensing cardiac signals with the implantable medical device;   altering the sensing vector based on the sensed cardiac signals.   
     
     
         19 . The method of  claim 18 , wherein altering the sensing vectors includes altering from a first sensing vector to a second sensing vector in response to the sensed cardiac signals satisfying a specified condition,
 wherein the first sensing vector includes a first combination of electrodes and the second sensing vector includes a second combination of electrodes, the first and second combinations of electrodes each selected from two or more electrodes on a first lead or one or more electrodes on a second lead, the second combination different from the first combination by at least one electrode.   
     
     
         20 . The method of  claim 18 , wherein altering the pacing vector includes altering from a first pacing vector to a second pacing vector in response to the sensed cardiac signals satisfying a specified condition, and wherein:
 the first pacing vector includes a first anode and a first cathode each selected from two or more electrodes on a first lead adapted to be positioned at or near a left ventricle; and   the second pacing vector includes a second anode and a second cathode each selected from the two or more electrodes on the first lead.   
     
     
         21 . The method of  claim 18 , wherein altering the pacing vector includes altering from a first pacing vector to a second pacing vector in response to the sensed cardiac signals satisfying a specified condition, and wherein:
 the first pacing vector includes a first cathode selected from two or more electrodes on a first lead adapted to be positioned at or near a left ventricle, and a first anode selected from one or more electrodes on a second lead adapted to be positioned at or near a region different from the left ventricle, and   the second pacing vector includes a second cathode selected from the two or more electrodes on the first lead, and a second anode selected from the one or more electrodes on the second lead.