Methods and systems for promoting ventricular pacing

• US 20040210266A1
• Filed: 03/05/2004
• Published: 10/21/2004
• Est. Priority Date: 04/04/1997
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Kramer, Andrew P.
• Granted Patent: US 7,483,739 B2
• Time in Patent Office: Days
• US Class Current: 607/25
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence

Abstract

A device and method for multi chamber pacing a patient'"'"'s heart having heart failure and intrinsic conduction, wherein ventricular tracking is used to pace the ventricle when the sinus rate exceeds a preset atrial maximum tracking rate. The ventricular tracking pacemaker increases the range of pacing the ventricle. The ventricular tracking minimizes the loss of ventricular pacing caused by intrinsic conduction when the sinus rate is below an atrial maximum tracking rate, and it induces a new ventricular pacing behavior for sinus rates above the atrial maximum tracking rate without any significant pacing hysteresis as the sinus rate returns towards the lower rate limit.

Claims

1. A method for pacing a heart, comprising:

providing a post ventricular atrial refractory period (PVARP) associated with a pacing timing sequence;

delivering a bi-ventricular pacing therapy using the pacing timing sequence;

detecting a disruption of ventricular pacing;

modifying the pacing timing sequence to restore ventricular pacing;

delivering the bi-ventricular pacing therapy using the modified pacing timing sequence; and

avoiding pacemaker mediated tachycardia during delivery of the bi-ventricular pacing therapy using the modified pacing timing sequence.

2. The method of claim 1, wherein detecting the disruption of ventricular pacing comprises detecting a premature ventricular contraction.

3. The method of claim 1, detecting the disruption of ventricular pacing comprises detecting a transient increase in heart rate above a maximum tracking rate.

4. The method of claim 1, wherein detecting the disruption of ventricular pacing comprises detecting one intrinsic atrial depolarization occurring within the PVARP.

5. The method of claim 1, wherein detecting the disruption of ventricular pacing comprises detecting an intrinsic ventricular depolarization.

6. The method of claim 1, wherein modifying the pacing timing sequence comprises adjusting the PVARP.

7. The method of claim 1, wherein modifying the pacing timing sequence comprises adjusting the PVARP for two or more successive cycles.

8. The method of claim 1, wherein modifying the pacing timing sequence comprises decreasing the PVARP.

9. The method of claim 1, wherein modifying the pacing timing sequence comprises ignoring the PVARP.

10. The method of claim 1, wherein delivering the bi-ventricular pacing therapy using the modified pacing timing sequence comprises avoiding pacemaker mediated tachycardia.

11. The method of claim 1, wherein delivering the bi-ventricular pacing therapy using the modified pacing timing sequence comprises restoring ventricular pacing following a premature ventricular contraction.

12. The method of claim 1, wherein delivering the bi-ventricular pacing therapy using the modified pacing timing sequence comprises restoring the ventricular pacing as an intrinsic atrial rate decreases below a maximum tracking rate.

13. The method of claim 1, wherein delivering the bi-ventricular pacing therapy using the modified pacing timing sequence comprises restoring ventricular pacing.

14. The method of claim 1, wherein delivering the bi-ventricular pacing therapy using the modified pacing timing sequence comprises avoiding pacing hysteresis as an intrinsic atrial rate decreases below a maximum tracking rate.

15. The method of claim 1, wherein delivering the bi-ventricular pacing therapy using the modified pacing timing sequence comprises pacing below an upper rate limit.

16. The method of claim 1, wherein delivering the bi-ventricular pacing therapy using the modified pacing timing sequence comprises implementing a ventricular tracking timing sequence.

17. The method of claim 1, further comprising interrupting the bi-ventricular pacing therapy using the modified pacing timing sequence if an intrinsic ventricular depolarization is detected.

18. The method of claim 1, wherein delivering the bi-ventricular therapy comprises:

selecting one or more ventricles selected from a left ventricle and a right ventricle; and

pacing the selected one or more ventricles.

19. The method or claim 1, wherein avoiding the pacemaker mediated tachycardia comprises:

detecting one or more pacemaker mediated tachycardia events; and

inhibiting atrial tracking based on the detection of the one or more pacemaker mediated tachycardia events.

20. The method or claim 1, wherein avoiding the pacemaker mediated tachycardia comprises:

detecting a retrograde p-wave; and

inhibiting initiation of a pacing escape interval based on the detection of the retrograde p-wave.

21. A cardiac rhythm management system, comprising:

a lead system comprising electrodes for electrically coupling to a heart, the electrodes configured to deliver stimulation pulses to right and left ventricles of the heart and to sense electrical activity of the heart; and

a pulse generator coupled to the lead system, the pulse generator configured to implement a post ventricular atrial refractory period (PVARP) associated with a pacing timing sequence, deliver a bi-ventricular pacing therapy using the pacing timing sequence, detect a disruption of ventricular pacing, modify the pacing timing sequence to restore ventricular pacing, deliver a bi-ventricular pacing therapy using the modified pacing timing sequence, and avoid pacemaker mediated tachycardia during delivery of the bi-ventricular pacing therapy using the modified pacing timing sequence.

22. The system of claim 21, wherein the disruption of ventricular pacing comprises one atrial event occurring within the PVARP.

23. The system of claim 21, wherein the disruption of ventricular pacing comprises two or more atrial events occurring respectively within two or more successive PVARPs.

24. The system of claim 21, wherein the disruption of ventricular pacing comprises an intrinsic ventricular depolarization.

25. The system of claim 21, wherein the disruption of ventricular pacing comprises a premature ventricular contraction.

26. The system of claim 21, wherein the pulse generator is configured to modify the pacing timing sequence by adjusting the PVARP.

27. The system of claim 21, wherein the pulse generator is configured to modify the pacing timing sequence by decreasing the PVARP.

28. The system of claim 21, wherein the pulse generator is configured to modify the pacing timing sequence by ignoring the PVARP.

29. The system of claim 21, wherein the modified pacing timing sequence is configured to avoid pacing hysteresis as an intrinsic atrial rate decreases below a maximum tracking rate.

30. The system of claim 21, wherein the modified pacing timing sequence is configured to restore ventricular pacing following a premature ventricular contraction.

31. The system of claim 21, wherein the modified pacing timing sequence is configured to restore ventricular pacing following a transient increase in heart rate above a maximum tracking rate.

32. The system of claim 21, wherein the modified pacing timing sequence is configured to restore ventricular pacing as an intrinsic atrial rate decreases below a maximum tracking rate.

33. The system of claim 21, wherein the modified pacing timing sequence is configured to pace at a rate below an upper rate limit.

34. The system of claim 21, wherein the modified pacing timing sequence comprises a ventricular tracking pacing protocol.

35. The system of claim 21, wherein the modified pacing timing sequence is configured to avoid pacemaker mediated tachycardia.

36. A cardiac pacing system, comprising:

means for providing a post ventricular atrial refractory period (PVARP) associated with a pacing timing sequence;

means for delivering a bi-ventricular pacing therapy using the pacing timing sequence;

means for detecting a disruption of ventricular pacing;

means for modifying the pacing timing sequence to restore ventricular pacing;

means for delivering the bi-ventricular pacing therapy using the modified pacing timing sequence; and

means for avoiding pacemaker mediated tachycardia during delivery of the bi-ventricular pacing therapy using the modified pacing timing sequence.

37. The system of claim 36, further comprising means for detecting one atrial event occurring within the PVARP.

38. The system of claim 36, further comprising means for adjusting the PVARP.

39. The system of claim 36, further comprising means for adjusting the PVARP for two or more successive beats.

40. The system of claim 36, further comprising means for decreasing the PVARP.

41. The system of claim 36, further comprising:

means for selecting one or more ventricles from a right ventricle and a left ventricle; and

means for pacing the selected one or more ventricles.

42. The system of claim 36, further comprising means for pacing a left ventricle and a right ventricle.

43. The system of claim 36, further comprising means for interrupting the modified pacing sequence if an intrinsic ventricular depolarization is detected during implementation of the modified pacing timing sequence.

44. A method for pacing a heart, comprising:

delivering a bi-ventricular pacing therapy using a first pacing timing sequence associated with a post ventricular atrial refractory period (PVARP);

detecting a cardiac event that disrupts consistent ventricular pacing;

adjusting the PVARP;

delivering a modified bi-ventricular pacing therapy using the adjusted PVARP; and

avoiding pacemaker mediated tachycardia during delivery of the modified bi-ventricular pacing therapy.