Ventricular safety pacing in biventricular pacing

• US 20030204208A1
• Filed: 04/25/2002
• Published: 10/30/2003
• Est. Priority Date: 04/25/2002
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Kramm, Berthold
• Granted Patent: US 6,996,437 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions

Abstract

A pacing method and apparatus includes providing an AV interval initiated by occurrence of either an atrial paced or sensed event. A ventricular safety pacing window is defined. In one embodiment, ventricular events are sensed at only one ventricular side and if a ventricular event is sensed during the ventricular safety pacing window, then a commitment is made to delivery of ventricular stimulus only to the one ventricular side of the patient'"'"'s heart where the ventricular event is sensed. Further, in another embodiment, sensing of ventricular events may occur at both ventricular sides during the ventricular safety pacing window. If a ventricular event is sensed during the ventricular safety pacing window at a first ventricular side, then commitment is made to delivery of ventricular stimulus to at least the first ventricular side. Further, upon such sensing, modification is provided to reduce the likelihood of sensing ventricular events at the second ventricular side for a predetermined time period following the sensing of the ventricular event at the first side.

Claims

1. A method of pacing for use in a medical device, the method comprising:

providing a paced AV delay following an atrial paced event, wherein the paced AV delay is a predetermined time period initiated by the atrial paced event;

defining a ventricular safety pacing window during at least an initial portion of the paced AV delay, wherein the paced AV delay further comprises a remainder period if the paced AV delay is longer than the ventricular safety pacing window;

sensing ventricular events at only one ventricular side of a patient'"'"'s heart;

delivering ventricular stimulus to the at least one ventricular side of the patient'"'"'s heart upon expiration of the paced AV delay if no ventricular events are sensed during the ventricular safety pacing window defined during at least the initial portion of the paced AV delay and the remainder portion of the paced AV delay;

inhibiting the delivery of ventricular stimulus upon expiration of the paced AV delay if no ventricular events are sensed during the ventricular safety pacing window but a ventricular event is sensed during the remainder portion of the paced AV delay; and

if a ventricular event is sensed during the ventricular safety pacing window, committing to delivery of ventricular stimulus upon expiration of the ventricular safety pacing window or the paced AV delay, which ever is shorter, only to the one ventricular side of the patient'"'"'s heart where ventricular events are sensed.

2. The method of claim 1, wherein the paced AV delay is 100 milliseconds to 180 milliseconds.

3. The method of claim 1, wherein the ventricular safety pacing window is in the range of about 70 milliseconds to 110 milliseconds.

4. The method of claim 1, wherein delivering ventricular stimulus to at least one ventricle upon expiration of the paced AV delay or ventricular safety pacing window, whichever is less, if no ventricular events are sensed during the ventricular safety pacing window defined during the initial portion of the paced AV delay and the remainder portion of paced AV delay comprises delivering bi-ventricular stimulus.

5. The method of claim 1, wherein the medical device is an implantable medical device.

6. The method of claim 5, wherein the implantable medical device includes an implantable medical device selected from one of a pacemaker, a defibrillator, a pacemaker/cardioverter/defibrillator, and a cardioverter/defibrillator.

7. The method of claim 1, wherein sensing ventricular events at only one ventricular side of a patient'"'"'s heart comprises sensing ventricular events at only the right ventricular side of the patient'"'"'s heart during the ventricular safety pacing window.

8. The method of claim 7, wherein the medical device is an implantable medical device, and further wherein the implantable medical device comprises an implantable cardioverter/defibrillator.

9. A method of pacing for use in a medical device, the method comprising:

providing an AV delay initiated by occurance of either an atrial sensed event or an atrial paced event, wherein the AV delay is a programmed time period;

defining a ventricular safety pacing window during at least an initial portion of the AV delay;

sensing ventricular events at only one ventricular side of a patient'"'"'s heart during at least the ventricular safety pacing window; and

if a ventricular event is sensed during the ventricular safety pacing window, then committing to delivery of ventricular stimulus only to the one ventricular side of the patient'"'"'s heart where the ventricular event is sensed.

10. The method of claim 9, delivering ventricular stimulus to both ventricular sides of the patient'"'"'s heart if no ventricular events are sensed during the AV delay or the ventricular safety pacing window.

11. The method of claim 9, wherein the method further comprises inhibiting delivery of ventricular stimulus upon expiration of the paced AV delay if a ventricular event is not sensed during the ventricular safety pacing window but a ventricular event is sensed during a subsequent portion of the AV interval following the ventricular safety pacing window.

12. The method of claim 9, wherein the ventricular safety pacing window is in a range of about 70 milliseconds to 110 milliseconds.

13. The method of claim 9, wherein if the ventricular event is sensed during the ventricular safety pacing window, then committing to delivery of ventricular stimulus upon expiration of the ventricular safety pacing window or the paced AV delay, which ever is less, only to the one ventricular side of the patient'"'"'s heart where the ventricular event is sensed.

14. The method of claim 9, wherein the medical device is an implantable medical device.

15. The method of claim 14, wherein the implantable medical device comprises an implantable medical device selected from one of a pacemaker, a defibrillator, a pacemaker/cardioverter/defibrillator, and a cardioverter/defibrillator.

16. The method of claim 9, wherein sensing ventricular events at only one ventricular side of a patient'"'"'s heart during at least the ventricular safety pacing window comprises sensing ventricular events at only the right ventricular side of a patient'"'"'s heart during at least the ventricular safety pacing window.

17. The method of claim 16, wherein the medical device is an implantable medical device, and further wherein the implantable medical device comprises an implantable cardioverter/defibrillator.

18. A method of pacing for use in a medical device, the method comprising:

providing an AV delay initiated by occurrence of either an atrial sensed event or an atrial paced event, wherein the AV delay is a programmed time period;

defining a ventricular safety pacing window during at least an initial portion of the AV delay;

sensing ventricular events at both ventricular sides of a patient'"'"'s heart during at least the ventricular safety pacing window;

if a ventricular event is sensed during the ventricular safety pacing window at a first ventricular side of the patient'"'"'s heart, then committing to the delivery of ventricular stimulus to at least the first ventricular side of the patient'"'"'s heart; and

modifying at least one parameter associated with sensing at the second ventricular side of the patient'"'"'s heart to reduce the likelihood of sensing ventricular events for a predetermined time period following the sensing of the ventricular event at the first side of the patient'"'"'s heart.

19. The method of claim 18, wherein modifying at least one parameter associated with sensing at the second ventricular side of the patient'"'"'s heart comprises providing a predetermined time period following the sensing of the ventricular event at the first side of the patient'"'"'s heart during which sensed signals at the second ventricular side are not recognized.

20. The method of claim 18, wherein modifying at least one parameter associated with sensing at the second ventricular side of the patient'"'"'s heart comprises adjusting a sensing threshold for sensing events at the second ventricular side during a period of time following the sensing of the ventricular event at the first side of the patient'"'"'s heart.

21. The method of claim 18, wherein modifying at least one parameter associated with sensing at the second ventricular side of the patient'"'"'s heart comprises providing a time period following the sensing of the ventricular event at the first side of the patient'"'"'s heart during which sensed signals at the second ventricular side are not recognized and also thereafter, adjusting a sensing threshold for sensing events at the second ventricular side during another period of time.

22. The method of claim 18, wherein the method further comprises delivering ventricular stimulus to both ventricular sides of the patient'"'"'s heart if no ventricular events are sensed during the ventricular safety pacing window or the AV delay.

23. The method of claim 18, wherein the method further comprises inhibiting delivery of ventricular stimulus upon expiration of the AV delay if a ventricular event is not sensed during the ventricular safety pacing window but a ventricular event is sensed during a subsequent portion of the AV delay following the ventricular safety pacing window.

24. The method of claim 18, wherein the ventricular safety pacing window is in the range of about 70 milliseconds to 110 milliseconds.

25. The method of claim 18, wherein if the ventricular event is sensed during the ventricular safety pacing window at a first ventricular side of the patient'"'"'s heart, then committing to the delivery of ventricular stimulus to at least the first ventricular side of the patient'"'"'s heart upon expiration of the ventricular safety pacing window or AV delay, whichever is less.

26. The method of claim 18, wherein the medical device is an implantable medical device.

27. The method of claim 26, wherein the implantable medical device comprises an implantable medical device selected from one of a pacemaker, a defibrillator, a pacemaker/cardioverter/defibrillator, and a cardioverter/defibrillator.

33. The apparatus of claim 27, wherein the ventricular pacing and sensing circuitry is operable to sense ventricular events at the right ventricular side of the patient'"'"'s heart.

34. The apparatus of claim 33, wherein the dual chamber apparatus comprises an implantable cardioverter/defibrillator.

28. A dual chamber pacing apparatus, the apparatus comprising:

atrial pacing circuitry operable to at least generate atrial pacing pulses;

ventricular pacing and sensing circuitry operable to generate ventricular pacing pulses for stimulating at least one ventricular side of a patient'"'"'s heart via at least one ventricular lead and for use in sensing ventricular events at only one ventricle side of the patient'"'"'s heart via the at least one ventricular lead; and

control circuitry operable to;

provide a paced AV delay following an atrial paced event, wherein the paced AV delay is a predetermined time period initiated by the atrial paced event;

define a ventricular safety pacing window during at least an initial portion of the paced AV delay, wherein the paced AV delay further comprises a remainder portion if the paced AV delay is longer than the ventricular safety pacing window;

sense ventricular events at only one ventricle side of a patient'"'"'s heart at least during the ventricular safety pacing window;

control delivery of ventricular stimulus using the ventricular pacing circuitry such that;

if no ventricular events are sensed during the ventricular safety pacing window defined during the initial portion of the paced AV delay and the remainder portion thereof, then ventricular stimulus is delivered to at least one ventricle upon expiration of the paced AV delay;

if no ventricular events are sensed during the ventricular safety pacing window but a ventricular event is sensed during the remainder portion of the paced AV delay, then inhibiting the delivery of ventricular stimulus upon expiration of the paced AV delay; and

if a ventricular event is sensed during the ventricular safety pacing window, committing to the delivery of a ventricular stimulus only to the ventricular side of the patient'"'"'s heart where ventricular events are sensed.

29. The apparatus of claim 28, wherein the control circuitry is operable to commit to the delivery of a ventricular stimulus only to the ventricular side of the patient'"'"'s heart where ventricular events are sensed upon expiration of the paced AV delay or the ventricular safety pacing window, whichever is less, if the ventricular event is sensed during the ventricular safety pacing window.

30. The apparatus of claim 28, wherein the ventricular safety pacing window is in the range of 70 milliseconds to 110 milliseconds.

31. The apparatus of claim 28, wherein if no ventricular events are sensed during the ventricular safety pacing window defined during the initial portion of the paced AV delay and any remainder portion thereof, then bi-ventricular stimulus is delivered.

32. The apparatus of claim 28, wherein the dual chamber apparatus comprises an implantable medical device selected from one of a pacemaker, a defibrillator, a pacemaker/cardioverter/defibrillator, and a cardioverter/defibrillator.

35. A dual chamber pacing apparatus, the apparatus comprising:

atrial pacing and sensing circuitry operable to at least generate atrial pacing pulses and sense atrial events;

ventricular pacing and sensing circuitry operable to generate ventricular pacing pulses for stimulating at least one ventricular side of a patient'"'"'s heart via at least one ventricular lead and for use in sensing ventricular events at only one ventricular side of the patient'"'"'s heart via the at least one ventricular lead; and

control circuitry operable to;

provide an AV delay initiated by occurrence of either an atrial sensed event or an atrial paced event, wherein the AV delay is a programmed time period;

define a ventricular safety pacing window during at least an initial portion of the AV delay;

sense ventricular events at only one ventricular side of the patient'"'"'s heart during at least the ventricular safety pacing window; and

control delivery of ventricular stimulus such that if a ventricular event is sensed during the ventricular safety pacing window, then committing to the delivery of ventricular stimulus only to the one ventricular side of the patient'"'"'s heart where ventricular events are sensed.

36. The apparatus of claim 35, wherein the control circuitry is operable to control delivery of ventricular stimulus such that if no ventricular events are sensed during the AV delay or the ventricular safety pacing window, then ventricular stimulus is delivered to both ventricular sides of the patient'"'"'s heart.

37. The apparatus of claim 35, wherein control circuitry is operable to inhibit delivery of ventricular stimulus after expiration of the ventricular safety pacing window or the AV delay if a ventricular event is not sensed during the ventricular safety pacing window but a ventricular event is sensed during a subsequent portion of the AV interval following the ventricular safety pacing window.

38. The apparatus of claim 35, wherein the ventricular safety pacing window is in the range of 70 milliseconds to 110 milliseconds.

39. The apparatus of claim 35, wherein the control circuitry is operable to control delivery of ventricular stimulus such that if the ventricular event is sensed during the ventricular safety pacing window, then committing to the delivery of ventricular stimulus after expiration of the ventricular safety pacing window or the AV delay, whichever is less, only to the one ventricular side of the patient'"'"'s heart where ventricular events are sensed.

40. The apparatus of claim 35, wherein the AV delay is less than the ventricular safety pacing window.

41. The apparatus of claim 35, wherein the dual chamber apparatus comprises an implantable medical device selected from one of a pacemaker, a defibrillator, a pacemaker/cardioverter/defibrillator, and a cardioverter/defibrillator.

42. The apparatus of claim 35, wherein the ventricular pacing and sensing circuitry is operable to sense ventricular events at only the right ventricular side of a patient'"'"' heart.

43. The apparatus of claim 42, wherein the dual chamber apparatus comprises an implantable cardioverter/defibrillator.

44. A dual chamber pacing apparatus, the apparatus comprising:

atrial pacing and sensing circuitry operable to generate atrial pacing pulses and sense atrial events;

ventricular pacing and sensing circuitry operable to generate ventricular pacing pulses for stimulating both ventricular sides of a patient'"'"'s heart via one or more ventricular leads and for use in sensing ventricular events in both ventricular sides via the one or more ventricular leads; and

control circuitry operable to;

provide an AV delay initiated by occurrence of either an atrial sensed event or an atrial paced event, wherein the AV delay is a programmed time period;

define a ventricular safety pacing window during at least an initial portion of the AV delay;

sense ventricular events at both ventricular sides of the patient'"'"'s heart during at least the ventricular safety pacing window;

control delivery of ventricular stimulus such that if a ventricular event is sensed during the ventricular safety pacing window at a first ventricular side of the patient'"'"'s heart, then committing to delivery of ventricular stimulus to at least the first ventricular side of the patient'"'"'s heart; and

modify at least one parameter associated with sensing at the second ventricular side of the patient'"'"'s heart to reduce the likelihood of sensing ventricular events for a predetermined time period following the sensing of the ventricular event at the first side of the patient'"'"'s heart.

45. The apparatus of claim 44, wherein the control circuitry operable to modify at least one parameter associated with sensing at the second ventricular side of the patient'"'"'s heart comprises means for providing a predetermined time period following the sensing of the ventricular event at the first side of the patient'"'"'s heart during which sensed signals at the second ventricular side are not recognized.

46. The apparatus of claim 44, wherein the control circuitry operable to modify at least one parameter associated with sensing at the second ventricular side of the patient'"'"'s heart comprises means for adjusting a sensing threshold for sensing events at the second ventricular side during a period of time following the sensing of the ventricular event at the first side of the patient'"'"'s heart.

47. The apparatus of claim 44, wherein the control circuitry operable to modify at least one parameter associated with sensing at the second ventricular side of the patient'"'"'s heart comprises means for providing a time period following the sensing of the ventricular event at the first side of the patient'"'"'s heart during which sensed signals at the second ventricular side are not recognized and also means for adjusting a sensing threshold for sensing events at the second ventricular side during another period of time.

48. The apparatus of claim 44, wherein the control circuitry is operable to deliver ventricular stimulus to both ventricles if no ventricular events are sensed during the ventricular safety pacing window or the AV delay.

49. The apparatus of claim 44, wherein the control circuitry is operable to inhibit delivery of ventricular stimulus upon expiration of the AV delay if a ventricular event is not sensed during the ventricular safety pacing window but a ventricular event is sensed during a subsequent portion of the AV delay following the ventricular safety pacing window.

50. The apparatus of claim 44, wherein the ventricular safety pacing window is in the range of 70 milliseconds to 110 milliseconds.

51. The apparatus of claim 44, wherein the control circuitry is operable to control delivery of ventricular stimulus such that if the ventricular event is sensed during the ventricular safety pacing window at a first ventricular side of the patient'"'"'s heart, then committing to delivery of ventricular stimulus to at least the first ventricular side of the patient'"'"'s heart upon expiration of the ventricular safety pacing window or AV delay, whichever is longer.

52. The apparatus of claim 44, wherein the dual chamber apparatus comprises an implantable medical device selected from one of a pacemaker, a defibrillator, a pacemaker/cardioverter/defibrillator, and a cardioverter/defibrillator.