Atrial tracking in an intracardiac ventricular pacemaker

• US 10,080,900 B2
• Filed: 04/28/2016
• Issued: 09/25/2018
• Est. Priority Date: 03/22/2016
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Ghosh, Subham, Kracker, Stefan, Sheldon, Todd J
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Morales, Jon Eric C
• Application Number:
  US15/140,585
• Publication Number:
  US 20170274213A1
• Time in Patent Office: 880 Days
• Field of Search: 607 25
• CPC Class Codes: A61B 5/026 Measuring blood flow A61B3/1233, A61B3/1241 take precedence
• CPC Class Codes: A61B 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61N 1/0573 chacterised by means penetrating the heart tissue, e.g. helix needle or hook
• CPC Class Codes: A61N 1/36571 controlled by blood flow rate, e.g. blood velocity or cardiac output
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/37205 Microstimulators, e.g. implantable through a cannula
• CPC Class Codes: A61N 1/3756 Casings with electrodes thereon, e.g. leadless stimulators

Abstract

An intracardiac ventricular pacemaker is configured to detect an atrial mechanical event from a motion sensor signal received by an atrial event detector circuit of the pacemaker. The motion sensor signal is responsive the motion of blood flowing in the ventricle. A pacing pulse is scheduled at an expiration of a pacing interval set by a pace timing circuit in response to detecting the atrial mechanical event. An atrial-synchronized ventricular pacing pulse is delivered upon expiration of the pacing interval.

Claims

1. An intracardiac ventricular pacemaker, comprising:

a housing;

a pulse generator within the housing, the pulse generator configured to generate and deliver a pacing pulse to a ventricle of a patient'"'"'s heart via electrodes coupled to the pacemaker;

a motion sensor within the housing, the motion sensor configured to produce an electrical signal;

a control circuit within the housing comprising an atrial event detector circuit coupled to the motion sensor;

a pace timing circuit within the housing, wherein the pace timing circuit is coupled to the pulse generator; and

a flow disturbance structure on the housing,

wherein the flow disturbance structure is configured to produce a vibration in response to movement of blood within the ventricle during an atrial systole,

wherein the flow disturbance structure is configured to transfer the vibration to the motion sensor within the housing, and

wherein the atrial event detector circuit is configured to detect an atrial mechanical event from the electrical signal of the motion sensor in response to the vibration, and pass an atrial event signal to the pace timing circuit in response to detecting the atrial mechanical event,

the pace timing circuit configured to schedule the pacing pulse by starting a pacing interval in response to receiving the atrial event signal, and

the pulse generator configured to deliver the scheduled pacing pulse to a ventricle of the patient'"'"'s heart in response to the pacing interval expiring.

2. The pacemaker of claim 1, where the atrial event detector circuit is configured to detect the atrial mechanical event by detecting a threshold crossing of the motion sensor signal.

3. The pacemaker of claim 1, wherein the atrial event detector circuit is further configured to:

detect a ventricular mechanical event from the motion sensor signal;

set a ventricular blanking period in response to the ventricular mechanical event detection; and

detect the atrial mechanical event in response to the motion sensor signal satisfying atrial event detection criteria outside the ventricular blanking period.

4. The pacemaker of claim 1, further comprising a sensing circuit configured to receive a cardiac electrical signal via the electrodes, sense a ventricular electrical event from the cardiac electrical signal and produce a ventricular sensed event signal in response to sensing the ventricular electrical event;

the atrial event detector circuit configured to receive the ventricular sensed event signal, set a ventricular blanking period in response to the ventricular sensed event signal, and detect the atrial mechanical event in response to the motion sensor signal satisfying atrial event detection criteria outside the ventricular blanking period.

5. The pacemaker of claim 1, further comprising a sensing circuit configured to receive a cardiac electrical signal via the electrodes,

the atrial event detector circuit being further configured to:

set a P-wave window in response to detecting the atrial mechanical event;

compare the cardiac electrical signal received during the P-wave window to atrial event confirmation criteria; and

pass the atrial event signal to the pace timing circuit in response to the atrial event confirmation criteria being met.

6. The pacemaker of claim 5, wherein the atrial event detector circuit is further configured to:

compare the cardiac electrical signal to atrial event confirmation criteria by determining a peak-to-peak amplitude difference of the cardiac electrical signal during the P-wave window;

compare the peak-to-peak amplitude difference to a peak amplitude threshold; and

determine that the atrial event confirmation criteria are met in response to the peak-to-peak amplitude difference being less than the peak amplitude threshold.

7. The pacemaker of claim 1, wherein the atrial event detector circuit is configured to detect the atrial mechanical event by determining from the motion sensor signal at least one of a first derivative, a peak slope, an area, a peak amplitude, or a frequency.

8. The pacemaker of claim 7, wherein the fixture is radially asymmetric with respect to the housing.

9. The pacemaker of claim 1, wherein the housing comprises:

a housing proximal end and a housing distal end, and

a lateral groove that causes the vibration of the housing when the pacemaker is subjected to blood flowing into the ventricle during the atrial systole.

10. The pacemaker of claim 1, wherein the housing is configured to carry the electrodes.

11. An intracardiac ventricular pacemaker, comprising:

a pulse generator configured to generate and deliver a pacing pulse to a ventricle of a patient'"'"'s heart via electrodes coupled to the pacemaker;

a motion sensor configured to produce an electrical signal correlated to movement of blood within the ventricle;

a control circuit comprising an atrial event detector circuit coupled to the motion sensor and a pace timing circuit coupled to the pulse generator;

a housing enclosing at least the pulse generator and the control circuit and having a housing proximal end and a housing distal end;

a fixation member coupled to the housing distal end for anchoring the housing at an implant site; and

a flow disturbance fixture having a first end coupled to the housing proximal end and a second end extending away from the housing,

the second end configured vibrate when the fixture is subjected to blood flow into the ventricle during atrial systole, the first end configured to transfer the vibrations to the motion sensor,

wherein the atrial event detector circuit is configured to detect an atrial mechanical event from the motion sensor signal and pass an atrial event signal to the pace timing circuit in response to detecting the atrial mechanical event,

the pace timing circuit configured to schedule the pacing pulse by starting a pacing interval in response to receiving the atrial event signal, and

the pulse generator configured to deliver the scheduled pacing pulse to a ventricle of the patient'"'"'s heart in response to the pacing interval expiring.

12. The pacemaker of claim 11, wherein the fixture comprises a first stiffness along a first axis of the fixture and a second stiffness along a second axis of the fixture that is less than the first stiffness,

the motion sensor comprising at least one axis of motion;

the second axis being aligned with the at least one axis of the accelerometer.

13. The pacemaker of claim 12, wherein the fixture has a first width along the first axis and a second width along the second axis that is less than the first width.

14. The pacemaker of claim 11, wherein the fixture is adjustable by at least one of rotating and bending.

15. A method for delivering cardiac pacing by an intracardiac ventricular pacemaker, the method comprising:

detecting an atrial mechanical event from a motion sensor signal received by an atrial event detector circuit within a housing of the pacemaker when the pacemaker is implanted in a ventricle of a patient, wherein a flow disturbance structure on the housing is configured to produce a vibration in response to movement of blood within the ventricle during an atrial systole, and wherein the flow disturbance structure is configured to transfer the vibration to the motion sensor;

passing an atrial event signal from the atrial event detector circuit to a pace timing circuit within the housing of the pacemaker in response to detecting the atrial mechanical event;

scheduling a pacing pulse at an expiration of a pacing interval by the pace timing circuit in response to the atrial event signal; and

delivering the pacing pulse to the ventricle by a pulse generator within the housing of the pacemaker via a pair of electrodes in response to the pacing interval expiring.

16. The method of claim 15, wherein detecting the atrial mechanical event comprises detecting an atrial event threshold crossing of the motion sensor signal.

17. The method of claim 15, further comprising:

detecting a ventricular mechanical event from the motion sensor signal;

setting a ventricular blanking period in response to the ventricular mechanical event detection; and

detecting the atrial mechanical event in response to the motion sensor signal meeting atrial event detection criteria outside the ventricular blanking period.

18. The method of claim 15, further comprising:

receiving a cardiac electrical signal via the electrodes;

sensing a ventricular electrical event from the cardiac electrical signal;

setting a ventricular blanking period in response to the sensed ventricular event; and

detecting the atrial mechanical event in response to the motion sensor signal meeting atrial event detection criteria outside the ventricular blanking period.

19. The method of claim 15, further comprising:

receiving a cardiac electrical signal by a sensing circuit of the pacemaker via the electrodes,

setting a P-wave window in response to detecting the atrial mechanical event;

comparing the cardiac electrical signal received during the P-wave window to atrial event confirmation criteria; and

passing the atrial event signal to the pace timing circuit in response to the atrial event confirmation criteria being met.

20. The pacemaker of claim 19, further comprising

comparing the cardiac electrical signal to atrial event confirmation criteria by determining a peak-to-peak amplitude difference of the cardiac electrical signal during the P-wave window;

comparing the peak-to-peak amplitude difference to a peak amplitude threshold; and

determining that the atrial event confirmation criteria are met in response to the peak-to-peak amplitude difference being less than the peak amplitude threshold.

21. The method of claim 15, wherein detecting the atrial mechanical event comprises determining from the motion sensor signal at least one of a first derivative, a peak slope, an area, a peak amplitude, and or a frequency.

22. The method of claim 15, further comprising detecting the atrial mechanical event in response to an increase in the motion sensor signal caused by an increase in vibrations of the flow disturbance structure on the housing of the pacemaker when the fixture is subjected to blood flow into the ventricle during the atrial systole.

23. The method of claim 22, further comprising detecting the atrial mechanical event in response to an increased motion sensor signal along an axis of motion of the motion sensor that is aligned with a first axis of the fixture having a first stiffness that is less than a second stiffness along a second axis of the fixture.

24. The method of claim 22 further comprising:

detecting the atrial mechanical event in response to an increase in the motion sensor signal caused by an increase in vibrations of the housing of the pacemaker having a lateral groove that causes the increase in vibrations of the housing when the housing is subjected to blood flow into the ventricle during atrial systole.

25. The method of 15, further comprising delivering the pacing pulse via electrodes coupled to the housing of the pacemaker.

26. A non-transitory computer-readable medium storing a set of instructions which when executed by an intracardiac ventricular pacemaker, cause the pacemaker to:

detect an atrial mechanical event from a motion sensor signal received by an atrial event detector circuit within a housing of the pacemaker, wherein a flow disturbance structure on the housing is configured to produce a vibration in response to movement of blood within the ventricle during an atrial systole, and wherein the flow disturbance structure is configured to transfer the vibration to the motion sensor;

passing an atrial event signal from the atrial event detector circuit to a pace timing circuit within the housing of the pacemaker in response to detecting the atrial event;

scheduling a pacing pulse at an expiration of a pacing interval by the pace timing circuit in response to the atrial event signal; and

delivering the pacing pulse to a ventricle of the patient by a pulse generator within the housing of the pacemaker via a pair of electrodes in response to the pacing interval expiring.