Identification of premature atrial contractions that trigger arrhythmia

• US 20040215273A1
• Filed: 04/25/2003
• Published: 10/28/2004
• Est. Priority Date: 04/25/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Van Bolhuis, Harm H., Westendorp, Henk, Stegink, Willem
• Granted Patent: US 7,734,346 B2
• Time in Patent Office: Days
• US Class Current: 607/27
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: C08J 9/24 by surface fusion and bonding of particles to form voids, e.g. sintering of expandable particles C08J9/232
• CPC Class Codes: C08J 9/26 by elimination of a solid phase from a macromolecular composition or article, e.g. leaching out

Abstract

In general, the invention is directed to techniques for delivery of pacing in response to a premature atrial contraction (PAC) to prevent atrial arrhythmia, i.e., delivery of post-PAC pacing pulses. The techniques may involve monitoring the success rate of prior post-PAC pacing sequences, and adjusting the number of post-PAC pacing pulses delivered subsequent post-PAC pacing sequences based on a success rate. In addition, the techniques may involve adjusting the post-PAC pacing interval based on the success rate.

Claims

1. An implantable medical device comprising:

a pulse generator to deliver pacing pulses to a chamber of the heart; and

a processor to determine whether a sensed premature contraction is likely to trigger an arrhythmia, and control the pulse generator based on the determination.

2. The device of claim 1, further comprising an implantable cardiac lead carrying a sense electrode to sense the premature contraction within the chamber of the heart.

3. The device of claim 1, wherein the processor controls the pulse generator to deliver the pacing pulses when the processor determines that the premature contraction is likely to trigger an arrhythmia, and controls the pulse generator to prevent delivery of the pacing pulses when the processor determines that the premature contraction is not likely to trigger an arrhythmia.

4. The device of claim 1, wherein the processor determines whether the premature contraction is likely to trigger an arrhythmia based on a coupling interval associated with the premature contraction.

5. The device of claim 1, wherein the processor determines whether the premature contraction is likely to trigger an arrhythmia based on one or more morphological parameters associated with the premature contraction.

6. The device of claim 1, wherein the processor determines whether the premature contraction is likely to trigger an arrhythmia based on a coupling interval and one or more morphological parameters associated with the premature contraction.

7. The device of claim 1, wherein the processor determines whether the premature contraction is likely to trigger an arrhythmia based on comparison of the premature contraction to predetermined criteria.

8. The device of claim 1, further comprising a memory storing a set of criteria, wherein the processor determines whether the premature contraction is likely to trigger an arrhythmia by comparing the premature contraction to the stored criteria.

9. The device of claim 8, wherein the stored criteria includes a range of coupling intervals indicative of premature contractions that are likely to trigger arrhythmia.

10. The device of claim 1, wherein the premature contraction is a premature atrial contraction, the device further comprising an implantable atrial lead carrying a sense electrode to sense the premature atrial contraction.

11. A method comprising:

sensing a premature contraction within a chamber of a heart;

determining whether the sensed premature contraction is likely to trigger an arrhythmia; and

controlling delivery of pacing pulses based on the determination.

12. The method of claim 11, further comprising sensing the premature contraction via a sense electrode carried by a lead implanted within the heart.

13. The method of claim 11, further comprising delivering the pacing pulses when the determination indicates that the premature contraction is likely to trigger an arrhythmia, and preventing delivery of the pacing pulses when the determination indicates that the premature contraction is not likely to trigger an arrhythmia.

14. The method of claim 11, further comprising determining whether the premature contraction is likely to trigger an arrhythmia based on a coupling interval associated with the premature contraction.

15. The method of claim 11, further comprising determining whether the premature contraction is likely to trigger an arrhythmia based on one or more morphological parameters associated with the premature contraction.

16. The method of claim 11, further comprising determining whether the premature contraction is likely to trigger an arrhythmia based on a coupling interval and one or more morphological parameters associated with the premature contraction.

17. The method of claim 11, further comprising determining whether the premature contraction is likely to trigger an arrhythmia based on comparison of the premature contraction to predetermined criteria.

18. The method of claim 11, further comprising storing a set of criteria in a memory associated with an implanted medical device, and determining whether the premature contraction is likely to trigger an arrhythmia by comparing the premature contraction to the stored criteria.

19. The method of claim 18, wherein the stored criteria includes a range of coupling intervals indicative of premature contractions that are likely to trigger arrhythmia.

20. The method of claim 11, wherein the premature contraction is a premature atrial contraction, the method further comprising sensing the premature atrial contraction via an implanted atrial lead carrying a sense electrode.

21. A computer-readable medium comprising instructions to cause a processor to:

determine whether a sensed premature contraction is likely to trigger an arrhythmia; and

control delivery of pacing pulses based on the determination.

22. The computer-readable medium of claim 21, further comprising instructions to cause the processor to direct delivery of the pacing pulses when the determination indicates that the premature contraction is likely to trigger an arrhythmia, and prevent delivery of the pacing pulses when the determination indicates that the premature contraction is not likely to trigger an arrhythmia.

23. The computer-readable medium of claim 21, further comprising instructions to cause the processor to determine whether the premature contraction is likely to trigger an arrhythmia based on a coupling interval associated with the premature contraction.

24. The computer-readable medium of claim 21, further comprising instructions to cause the processor to determine whether the premature contraction is likely to trigger an arrhythmia based on one or more morphological parameters associated with the premature contraction.

25. The computer-readable medium of claim 21, further comprising instructions to cause the processor to determine whether the premature contraction is likely to trigger an arrhythmia based on a coupling interval and one or more morphological parameters associated with the premature contraction.

26. The computer-readable medium of claim 21, further comprising instructions to cause the processor to determine whether the premature contraction is likely to trigger an arrhythmia based on comparison of the premature contraction to predetermined criteria.

27. The computer-readable medium of claim 21, further comprising instructions to cause the processor to store a set of criteria in a memory associated with an implanted medical device, and determine whether the premature contraction is likely to trigger an arrhythmia by comparing the premature contraction to the stored criteria.

28. The computer-readable medium of claim 27, wherein the stored criteria includes a range of coupling intervals indicative of premature contractions that are likely to trigger arrhythmia.

29. The computer-readable medium of claim 21, wherein the premature contraction is a premature atrial contraction.

30. A method comprising:

sensing premature contractions over a period of time;

identifying one or more characteristics of the premature contractions;

determining whether the premature contractions trigger arrhythmia; and

generating criteria associating the identified characteristics with an indication that premature contractions will trigger arrhythmia.

31. The method of claim 30, further comprising sensing the premature contraction via a sense electrode carried by a lead implanted within the heart.

32. The method of claim 30, wherein the characteristics include a coupling interval associated with the premature contractions.

33. The method of claim 30, wherein the characteristics include one or more morphological parameters associated with the premature contraction.

34. The method of claim 30, wherein the characteristics include a coupling interval associated with the premature contractions, and the criteria specify a coupling interval range indicative of premature contractions likely to trigger arrhythmia.

35. The method of claim 30, wherein the characteristics include one or more morphological parameters associated with the premature contractions, and the criteria specify a morphological parameter range indicative of premature contractions likely to trigger arrhythmia.

36. The method of claim 30, further comprising sensing the premature contractions via a sense electrode carried by a lead implanted within the heart, wherein the lead is coupled to an implanted medical device.

37. The method of claim 30, wherein the premature contraction is a premature atrial contraction, the method further comprising sensing the premature atrial contraction via an implanted atrial lead carrying a sense electrode.

38. A method comprising:

sensing a premature contraction within a chamber of a heart;

determining whether the sensed premature contraction is likely to trigger an arrhythmia; and

selectively delivering therapy based on the determination.

39. The method of claim 38, wherein the therapy includes pacing pulses.

40. The method of claim 38, wherein the therapy includes drug delivery.

41. The method of claim 38, wherein the therapy includes a surgical procedure.

42. The method of claim 38, wherein the premature contraction is an atrial contraction.

43. The method of claim 38, further comprising determining whether the sensed premature contraction is likely to trigger an arrhythmia based on at least one of a coupling interval and a morphology characteristic of the premature contraction.