Cardiac rhythm management system selecting A-V delay based on interval between atrial depolarization and mitral valve closure
First Claim
Patent Images
1. A method including:
- providing ventricular stimulations, separated from corresponding preceding atrial depolarizations, occurring during the same cardiac cycle, by different atrioventricular (A-V) delays;
detecting mitral valve closures associated with each ventricular stimulation;
measuring time intervals between the atrial depolarizations and the mitral valve closures; and
selecting, based on the time intervals, an A-V delay for subsequent delivery of ventricular stimulations.
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Abstract
A cardiac rhythm management system selects an atrioventricular (A-V) delay based on a time-interval between an atrial depolarization and mitral valve closure (MVC). For several different A-V delays, the system measures time intervals between atrial depolarizations (i.e., sensed or paced P-waves) and accelerometer-detected MVCs. Based on this information, the system selects a particular A-V delay for improving cardiac output during subsequent delivery of cardiac rhythm management therapy.
31 Citations
29 Claims
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1. A method including:
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providing ventricular stimulations, separated from corresponding preceding atrial depolarizations, occurring during the same cardiac cycle, by different atrioventricular (A-V) delays;
detecting mitral valve closures associated with each ventricular stimulation;
measuring time intervals between the atrial depolarizations and the mitral valve closures; and
selecting, based on the time intervals, an A-V delay for subsequent delivery of ventricular stimulations. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28)
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15. A method including:
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providing ventricular stimulations separated from corresponding preceding atrial depolarizations by different atrioventricular (A-V) delays;
detecting an acceleration signal associated with the heart;
differentiating the acceleration signal to form a first derivative acceleration signal;
detecting, for each ventricular stimulation, a corresponding mitral valve closure, occurring during the same cardiac cycle as the ventricular stimulation and the preceding atrial depolarization, by detecting a peak of the first derivative acceleration signal, wherein the peak occurs after an R-wave associated with the ventricular stimulation and before a P-wave associated with a next atrial depolarization;
measuring P-MVC time intervals between the atrial depolarizations and the corresponding mitral valve closures;
calculating slopes of the P-MVC time intervals against the different A-V delays; and
selecting, based on the slopes, an A-V delay for subsequent delivery of ventricular stimulations.
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16. A method including:
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providing ventricular stimulations, separated from preceding atrial depolarizations by different atrioventricular (A-V) delays;
detecting a mitral valve closure associated with each ventricular stimulation;
measuring P-MVC time intervals between the atrial depolarizations and the mitral valve closures;
calculating slopes of the P-MVC time intervals against the different A-V delays; and
selecting, for subsequent delivery of ventricular stimulations, the shortest of the A-V delays with which an adjacent shorter one of the A-V delays provides a larger slope than an adjacent longer one of the A-V delays.
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17. A method including:
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providing ventricular stimulations, separated from preceding atrial depolarizations by different atrioventricular (A-V) delays;
detecting a mitral valve closure associated with each ventricular stimulation;
measuring P-MVC time intervals between the atrial depolarizations and the mitral valve closures;
storing the P-MVC time intervals and the corresponding different A-V delays;
forming a first linear approximation of the P-MVC time intervals at small A-V delays;
forming a second linear approximation of P-MVC time intervals at large A-V delays, relative to the small A-V delays. finding an intersection between the first and second linear approximations; and
selecting an A-V delay associated with the intersection for subsequent delivery of ventricular stimulations.
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18. A system, including:
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an atrial module selected from the group consisting essentially of an atrial stimulation module and an atrial sensing module;
a ventricular stimulation module;
a mitral valve closure detector;
an atrioventricular (A-V) timing module, coupled to the atrial module and the ventricular stimulation module, for controlling the delivery of ventricular stimulations at different A-V delays;
a timer, coupled to the mitral valve closure detector for receiving times associated with mitral valve closures, and coupled to the atrial module for receiving times associated with the atrial depolarizations, the timer calculating, for each ventricular stimulation, a time interval between the preceding atrial depolarization and a next mitral valve closure following the ventricular stimulation; and
an A-V delay selection module, coupled to the timer and selecting an A-V delay based on the time intervals.
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29. A system, including:
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an atrial electrode, configured to be associated with an atrium of a heart;
an atrial module, selected from the group consisting of an atrial stimulation module and an atrial sensing module, the atrial module coupled to the atrial electrode;
a ventricular electrode, configured to be associated with a ventricle of the heart;
a ventricular stimulation circuit, coupled to the ventricular electrode for delivering ventricular stimulations;
an accelerometer, configured to be associated with the heart for detecting and providing a heart acceleration signal;
an accelerometer interface module, including an input coupled to the accelerometer for receiving the heart acceleration signal, and including an output providing fiducial points associated with mitral valve closures obtained from the heart acceleration signal;
an atrioventricular (A-V) timing module, coupling the ventricular stimulation circuit to the ventricular electrode for delivering ventricular stimulations separated from corresponding preceding atrial depolarizations by different A-V delays;
a timer, coupled to the accelerometer interface module for receiving the fiducial points, and coupled to the A-V timing module for receiving times associated with the atrial depolarizations, the timer calculating, for each ventricular stimulation, a P-MVC time interval between the atrial depolarization and the fiducial point following the ventricular stimulation;
a slope calculation module, calculating the slopes of the P-MVC time intervals against the different A-V delays; and
an A-V delay selection module, selecting an A-V delay based on the slopes of the P-MVC time intervals.
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Specification