Forced deceleration algorithm for synchronization of atrial cardioversion shock and technique for the implementation
First Claim
1. An atrial cardioverter comprising:
- means for monitoring an interval between successive R-waves;
means for calculating at least one mean for the successive R-waves;
means for prolongation of an interval between the successive R-waves;
means for identifying a reproducible interval;
means for activating a capacitor charge upon confirmation of presence of the reproducible interval;
means for confirming presence of at least one atrial fibrillation episode upon completion of the capacitor charge; and
means for delivering a ventricular synchronized atrial cardioversion shock.
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Abstract
Primarily, the invention relates to a safe delivery of atrial cardioversion pulses in complex cardiac therapy environments wherein cardiac events suggest, for example, rapid ventricular rates that would prevent a safe atrial cardioversion. The invention generally utilizes an algorithmic system in which a resultant R-R interval encountered subsequent to the delivery of a ventricular pacing pulse is decrementally scanned until an R-R interval is found that will yield a reliable sustained R-R interval. The sustenance of the R-R interval prolongation enables ventricular deceleration. Strategically selected timing windows are used to trigger a device response that is proper and tailored to the ventricular event detected during and within the timing windows. Further, the invention enables an atrial cardioversion synchronization method that allows for the safe delivery of atrial cardioversion pulses in the presence of very rapid ventricular rates.
78 Citations
26 Claims
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1. An atrial cardioverter comprising:
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means for monitoring an interval between successive R-waves;
means for calculating at least one mean for the successive R-waves;
means for prolongation of an interval between the successive R-waves;
means for identifying a reproducible interval;
means for activating a capacitor charge upon confirmation of presence of the reproducible interval;
means for confirming presence of at least one atrial fibrillation episode upon completion of the capacitor charge; and
means for delivering a ventricular synchronized atrial cardioversion shock. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. A method of atrial cardioversion comprising:
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measuring R-R intervals and R-waves to determine a mean ventricular interval;
using said mean as a reference to a percent of decrementation for a paced interval;
delivering a ventricular pacing output pulse at the end of a decremented escape interval;
initiating a blanking period;
initiating an abort and reset period upon termination of a blanking period; and
beginning a shock synchronization period upon expiration of the abort and reset period. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22)
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23. A microprocessor-implemented software system including executable codes adapted to co-operate with an atrial cardioverter medical device for operating the medical device to deliver a cardioversion or defibrillation pulse comprising:
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a process for determining the status of various synchronization options to initiate measurement of intervals between R-waves;
a process for deriving a mean interval for the measurement of the intervals;
a process for setting a decrement from the mean for a ventricular escape interval;
a process for delivering an overdrive pacing output pulse;
a process for determining whether a ventricular sensed event occurred within the shock synchronization period;
a process for checking to determine if the V-R is greater than a certain interval;
a process for delivering an atrial cardioversion shock; and
a process for indicating of whether synchronization has been successful. - View Dependent Claims (24, 25)
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26. A microprocessor-implemented software system containing executable codes adapted to cooperate with an atrial cardioverter medical device for operating the medical device to deliver a cardioversion or defibrillation pulse comprising:
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a process for detecting atrial tachyarrhythmia;
a process for delivering a ventricular synchronized atrial cardioversion pulse responsive to the atrial tachyarrhythmia;
a process for delivering the synchronized pulse using at least one alternative method; and
a process for returning to brady cardia pacing after delivery of the synchronized atrial cardioversion pulse.
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Specification