Av synchronous vfa cardiac therapy

Abstract

VfA cardiac therapy uses an implantable medical device or system. The implantable medical device includes a tissue-piercing electrode implanted in the basal and/or septal region of the left ventricular myocardium of the patient's heart from the triangle of Koch region of the right atrium through the right atrial endocardium and central fibrous body. The device may include a right atrial electrode, a right atrial motion detector, or both. The device may be implanted completely within the patient's heart or may use one or more leads to implant electrodes in the patient's heart. The device may be used to provide cardiac therapy, including single or multiple chamber pacing, atrioventricular synchronous pacing, asynchronous pacing, triggered pacing, cardiac resynchronization pacing, or tachycardia-related therapy. A separate medical device may be used to provide some functionality for cardiac therapy, such as sensing, pacing, or shock therapy.

What is claimed is: 
     
         1 . An implantable medical device comprising:
 a set of electrodes comprising:
 a tissue-piercing electrode implantable from a triangle of Koch region of a right atrium to at least one of deliver cardiac therapy to and sense electrical activity of a left ventricle in a basal region, septal region, or basal septal region of a left ventricular myocardium of a patient's heart, and 
 a plurality of right atrial electrodes positionable within the right atrium and selectably employable to at least one of deliver cardiac therapy and sense electrical activity of the right atrium of the patient's heart; and 
   a therapy delivery circuit operably coupled to the set of electrodes to deliver cardiac therapy to the patient's heart; and   a sensing circuit operably coupled to the set of electrodes to sense electrical activity of the patient's heart.   
     
     
         2 . A device according to  claim 1 , comprising a controller comprising processing circuitry operably coupled to the therapy delivery circuit and the sensing circuit, the controller configured to monitor electrical activity of the right atrium using the sensing circuit selectably coupled to one or more of the plurality of right atrial electrodes to sense atrial events and to deliver atrioventricular synchronous pacing using the therapy delivery circuit and the tissue-piercing electrode to pace one or both ventricles based on the monitored electrical activity of the right atrium. 
     
     
         3 . A device according to  claim 2 , wherein delivering atrioventricular synchronous pacing comprises sensing an atrial event using the sensing circuit and delivering a pacing pulse to the tissue-piercing electrode in response to the sensed atrial event. 
     
     
         4 . A device according to  claim 1 , further comprising a controller comprising processing circuitry operably coupled to the therapy delivery circuit and the sensing circuit, the controller configured to deliver atrioventricular synchronous pacing using the therapy delivery circuit selectably coupled to one or more of the plurality of right atrial electrodes to pace the atrium and using at least the tissue-piercing electrode to pace one or both ventricles. 
     
     
         5 . A device according to  claim 1 , further comprising a controller comprising processing circuitry operably coupled to the therapy delivery circuit and the sensing circuit, the controller configured to monitor to monitor ventricular events using sensing circuit and the tissue-piercing electrode and withhold delivery of pacing pulses to the tissue piercing electrode in response to sensing a ventricular event. 
     
     
         6 . A device according to  claim 1 , wherein the therapy delivery circuit, the sensing circuit and the controller are located in a housing coupled to the set of electrodes by a first implantable lead extending therebetween. 
     
     
         7 . A device according to  claim 6 , further comprising a second implantable lead extending from the housing. 
     
     
         8 . A device according to  claim 1 , wherein the therapy delivery circuit, the sensing circuit and the controller are located in a housing on which the set of electrodes are mounted without an implantable lead extending therebetween. 
     
     
         9 . A device according to  claim 8 , wherein the housing extends from a proximal end region to a distal end region, wherein the plurality of right atrial electrodes is are leadlessly coupled to the housing and the tissue-piercing electrode is leadlessly coupled to the distal end region of the housing. 
     
     
         10 . A device according to  claim 9 , further comprising a fixation member that extends from the housing, the fixation member being configured to pierce into the myocardium, wherein the fixation member extends from the distal end region of the housing toward a distal tip of the tissue-piercing electrode. 
     
     
         11 . A method of delivering cardiac therapy, comprising:
 implanting and employing a set of electrodes comprising:
 a tissue-piercing electrode implantable from a triangle of Koch region of a right atrium to at least one of deliver cardiac therapy to and sense electrical activity of a left ventricle in a basal region, septal region, or basal septal region of a left ventricular myocardium of a patient's heart, and 
 a plurality of right atrial electrodes positionable within the right atrium and selectably employable to at least one of deliver cardiac therapy and sense electrical activity of the right atrium of the patient's heart; and 
 operably coupling a therapy delivery circuit to the set of electrodes to deliver cardiac therapy to the patient's heart; and 
   operably coupling a sensing circuit to the set of electrodes to sense electrical activity of the patient's heart.   
     
     
         12 . A method according to  claim 11 , further comprising selectably coupling one or more of the plurality of atrial electrodes to the sensing circuit and employing a controller comprising processing circuitry operably coupled to the therapy delivery circuit and the sensing circuit to monitor electrical activity of the right atrium using the sensing circuit to monitor electrical activity of the right atrium and to deliver atrioventricular synchronous pacing using the therapy delivery circuit and the tissue-piercing electrode to pace one or both ventricles based on the monitored electrical activity of the right atrium. 
     
     
         13 . A method according to  claim 12 , wherein delivering atrioventricular synchronous pacing comprises sensing an atrial event using the sensing circuit and delivering a pacing pulse to the tissue-piercing electrode in response to the sensed atrial event. 
     
     
         14 . A method according to  claim 11 , comprising selectably coupling one or more of the plurality of atrial electrodes to the therapy delivery circuit and employing a controller comprising processing circuitry operably coupled to the therapy delivery circuit and the sensing circuit to deliver atrioventricular synchronous pacing using the therapy delivery circuit, the selected one or more of the plurality of atrial electrodes and the tissue-piercing electrode. 
     
     
         15 . A method according to  claim 11 , further comprising employing a controller comprising processing circuitry operably coupled to the therapy delivery circuit and the sensing circuit to monitor ventricular events using sensing circuit and the tissue-piercing electrode and withhold delivery of pacing pulses to the tissue piercing electrode in response to sensing a ventricular event. 
     
     
         16 . A method according to  claim 11 , wherein the therapy delivery circuit, the sensing circuit and the controller are located in a housing and comprising coupling the housing to the set of electrodes using a first implantable lead extending therebetween. 
     
     
         17 . A method according to  claim 16 , further comprising coupling a second implantable lead to the housing. 
     
     
         18 . A method according to  claim 11 ., wherein the therapy delivery circuit, the sensing circuit and the controller are located in a housing on which the set of electrodes are mounted without an implantable lead extending therebetween. 
     
     
         19 . A method according to  claim 18 , wherein the housing extends from a proximal end region to a distal end region, wherein the plurality of right atrial electrodes is are leadlessly coupled to the housing and the tissue-piercing electrode is leadlessly coupled to the distal end region of the housing. 
     
     
         20 . A method according to  claim 19 , wherein a fixation member is provided extending from the distal end region of the housing and employing the fixation member to attach the housing to the triangle of Koch region of the right atrium.