System and method for timing synchronized pacing

• US 20040225330A1
• Filed: 06/09/2004
• Published: 11/11/2004
• Est. Priority Date: 12/26/2000
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Kramer, Andrew P.
• Granted Patent: US 7,392,083 B2
• Time in Patent Office: Days
• US Class Current: 607/9
• 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 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A device and method for cardiac rhythm management in which a heart chamber is paced in accordance with sense signals from the opposite chamber or other distant cardiac site. The method is particularly useful in delivering cardiac resynchronization therapy.

Claims

1. A method for operating a cardiac rhythm management device, comprising:

sensing a right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle;

pacing the left and right ventricles in accordance with expiration of an escape interval, wherein the left ventricle is paced before the right ventricle; and

,

restarting the escape interval after a right ventricular sense.

2. The method of claim 1 wherein the right ventricle is paced upon expiration of the escape interval and the left ventricle is paced at a pacing instant defined to occur prior to expiration of the escape interval by a specified offset interval.

3. The method of claim 1 further comprising restarting the escape interval after a right ventricular pace.

4. The method of claim 1 further comprising modulating the escape interval in a rate-adaptive pacing mode.

5. The method of claim 1 further comprising:

sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

6. The method of claim 1 wherein the right ventricular pace is committed to occur once the left ventricular pace is delivered and cannot be inhibited.

7. A method for operating a cardiac rhythm management device, comprising:

initiating an atrio-ventricular escape interval based on an atrial event;

sensing a right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle;

pacing the left and right ventricles in accordance with expiration of the atrio-ventricular escape interval, wherein the left ventricle is paced before the right ventricle; and

,

stopping the atrio-ventricular escape interval after a right ventricular sense.

8. The method of claim 7 further comprising:

sensing an atrium and generating an atrial sense upon detection of a depolarization; and

,

starting the atrio-ventricular escape interval upon occurrence of an atrial sense.

9. The method of claim 7 wherein the right ventricle is paced upon expiration of the atrio-ventricular escape interval and the left ventricle is paced at a pacing instant defined to occur prior to expiration of the atrio-ventricular escape interval by a specified offset interval.

10. The method of claim 8 further comprising:

pacing an atrium upon expiration of an atrial escape interval which is restarted by an atrial pace or an atrial sense; and

,

starting the atrio-ventricular escape interval after an atrial pace.

11. The method of claim 7 further comprising modulating the atrial escape interval in a rate-adaptive pacing mode.

12. The method of claim 7 further comprising:

sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

13. The method of claim 7 wherein the right ventricular pace is committed to occur once the left ventricular pace is delivered and cannot be inhibited.

14. A method for operating a cardiac rhythm management device, comprising:

sensing the right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle;

pacing the left and right ventricles in accordance with expiration of an escape interval, wherein the left ventricle is paced after the right ventricle and further wherein the pace to the left ventricle is committed to occur once the right ventricular pace is delivered and cannot be inhibited;

restarting the escape interval after a right ventricular pace; and

,

restarting the escape interval after a right ventricular sense.

15. The method of claim 14 further comprising:

sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

16. The method of claim 14 further comprising modulating the escape interval in a rate-adaptive pacing mode.

17. A method for operating a cardiac rhythm management device, comprising:

initiating an atrio-ventricular escape interval based on an atrial event;

sensing the right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle;

pacing the left and right ventricles in accordance with expiration of an atrio-ventricular escape interval, wherein the left ventricle is paced after the right ventricle and further wherein the pace to the left ventricle is committed to occur once the right ventricular pace is delivered and cannot be inhibited; and

,

stopping the atrio-ventricular escape interval after a right ventricular sense.

18. The method of claim 17 further comprising:

sensing an atrium and generating an atrial sense upon detection of a depolarization; and

,

starting the atrio-ventricular escape interval upon occurrence of an atrial sense.

19. The method of claim 17 further comprising stopping the atrio-ventricular escape interval during a cardiac cycle after a right ventricular sense so that no right or left ventricular pace is delivered during the cardiac cycle.

20. The method of claim 17 further comprising:

sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

21. The method of claim 18 further comprising:

pacing an atrium upon expiration of an atrial escape interval which is restarted by an atrial pace or an atrial sense; and

,

starting the atrio-ventricular escape interval after an atrial pace.

22. The method of claim 17 further comprising modulating the atrial escape interval in a rate-adaptive pacing mode.

23. A method for operating a cardiac rhythm management device, comprising:

sensing the right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle;

pacing the left ventricle upon expiration of an escape interval;

restarting the escape interval after a right ventricular sense; and

,

restarting the escape interval after a left ventricular pace.

24. The method of claim 23 wherein no pace is delivered to the right ventricle during a cardiac cycle in which a pace is delivered to the left ventricle.

25. The method of claim 23 wherein the escape interval is restarted at the time of a left ventricular pace by delivering a right ventricular pseudo-pace.

26. The method of claim 23 further comprising:

sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

27. The method of claim 23 further comprising modulating the escape interval in a rate-adaptive pacing mode.

28. A method for operating a cardiac rhythm management device, comprising:

initiating an atrio-ventricular escape interval based on an atrial event;

sensing the right ventricle and generating a right ventricular sense upon detection of depolarization occurring in the right ventricle;

pacing the left ventricle upon expiration of the atrio-ventricular escape interval; and

,

stopping the atrio-ventricular escape interval upon occurrence of a right ventricular sense.

29. The method of claim 28 further comprising:

sensing an atrium and generating an atrial sense upon detection of a depolarization; and

,

starting the atrio-ventricular escape interval upon occurrence of an atrial sense.

30. The method of claim 28 further comprising:

sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

31. A cardiac rhythm management device, comprising:

electrodes for pacing and sensing a right ventricle and for pacing a left ventricle;

wherein the left and right ventricles are paced in accordance with expiration of an escape interval, and wherein the left ventricle is paced before the right ventricle; and

,

circuitry for restarting the escape interval after a right ventricular sense.

32. The device of claim 31 wherein the device is configured to pace the right ventricle upon expiration of the escape interval and pace the left ventricle at a pacing instant defined to occur prior to expiration of the escape interval by a specified offset interval.

33. The device of claim 31 wherein the device is configured to restart the escape interval after a right ventricular pace.

34. The device of claim 31 further comprising an exertion level sensor and wherein the device is configured to modulate the escape interval in a rate-adaptive pacing mode.

35. The device of claim 31 further comprising:

a sensing channel for sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

wherein the device is configured to inhibit the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

36. The device of claim 31 wherein the device is configured so that a right ventricular pace is committed to occur once the left ventricular pace is delivered and cannot be inhibited.

37. A cardiac rhythm management device, comprising:

circuitry for initiating an atrio-ventricular escape interval based on an atrial event;

electrodes for pacing and sensing a right ventricle and for pacing a left ventricle;

wherein the left and right ventricles are paced in accordance with expiration of the atrio-ventricular escape interval and wherein the left ventricle is paced before the right ventricle; and

,

circuitry for stopping the atrio-ventricular escape interval after a right ventricular sense.

38. The device of claim 37 further comprising:

an electrode for sensing an atrium; and

,

circuitry for starting the atrio-ventricular escape interval upon occurrence of an atrial sense.

39. The device of claim 37 wherein the device is configured to pace the right ventricle upon expiration of the atrio-ventricular escape interval and pace the left ventricle at a pacing instant defined to occur prior to expiration of the atrio-ventricular escape interval by a specified offset interval.

40. The device of claim 38 further comprising:

an electrode for pacing an atrium, wherein the atrium is paced upon expiration of an atrial escape interval which is restarted by an atrial pace or an atrial sense; and

,

circuitry for starting the atrio-ventricular escape interval after an atrial pace.

41. The device of claim 37 further comprising an exertion level sensor and wherein the device is configured to modulate the atrial escape interval in a rate-adaptive pacing mode.

42. The device of claim 37 further comprising:

a sensing channel for sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

43. The device of claim 37 wherein the device is configured so that the right ventricular pace is committed to occur once the left ventricular pace is delivered and cannot be inhibited.

44. A cardiac rhythm management device, comprising:

electrodes for sensing and pacing a right ventricle and for pacing a left ventricle;

wherein the left and right ventricles are paced in accordance with expiration of an escape interval, and further wherein the device is configured so that the left ventricle is paced after the right ventricle and configured so that the pace to the left ventricle is committed to occur once the right ventricular pace is delivered and cannot be inhibited;

circuitry for restarting the escape interval after a right ventricular pace; and

,

circuitry for restarting the escape interval after a right ventricular sense.

45. The device of claim 44 further comprising:

a sensing channel for sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

46. The device of claim 44 further comprising an exertion level sensor and wherein the device is configured to modulate the escape interval in a rate-adaptive pacing mode.

47. A cardiac rhythm management device, comprising:

circuitry for initiating an atrio-ventricular escape interval based on an atrial event;

electrodes for pacing and sensing the right ventricle and for pacing the left ventricle;

wherein the left and right ventricles are paced in accordance with expiration of an atrio-ventricular escape interval, wherein the left ventricle is paced after the right ventricle, and further wherein the pace to the left ventricle is committed to occur once the right ventricular pace is delivered and cannot be inhibited; and

,

circuitry for stopping the atrio-ventricular escape interval after a right ventricular sense.

48. The device of claim 47 further comprising:

an electrode for sensing an atrium; and

,

circuitry for starting the atrio-ventricular escape interval upon occurrence of an atrial sense.

49. The device of claim 47 further comprising circuitry for stopping the atrio-ventricular escape interval during a cardiac cycle after a right ventricular sense so that no right or left ventricular pace is delivered during the cardiac cycle.

50. The device of claim 47 further comprising:

a sensing channel for sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

51. The device of claim 48 further comprising:

an electrode for pacing an atrium, wherein the atrium is paced upon expiration of an atrial escape interval which is restarted by an atrial pace or an atrial sense; and

,

circuitry for starting the atrio-ventricular escape interval after an atrial pace.

52. The device of claim 47 further comprising an exertion level sensor and circuitry for modulating the atrial escape interval in a rate-adaptive pacing mode.

53. A cardiac rhythm management device, comprising:

electrodes for sensing the right ventricle and pacing the left ventricle;

wherein the left ventricle is paced upon expiration of an escape interval;

circuitry for restarting the escape interval after a right ventricular sense; and

,

circuitry for restarting the escape interval after a left ventricular pace.

54. The device of claim 53 wherein the device is configured so that no pace is delivered to the right ventricle during a cardiac cycle in which a pace is delivered to the left ventricle.

55. The device of claim 53 wherein the escape interval is restarted at the time of a left ventricular pace by delivering a right ventricular pseudo-pace.

56. The device of claim 53 further comprising:

a sensing channel for sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.

57. The device of claim 53 further comprising an exertion level sensor and circuitry for modulating the escape interval in a rate-adaptive pacing mode.

58. A cardiac rhythm management device, comprising:

circuitry for initiating an atrio-ventricular escape interval based on an atrial event;

electrodes for sensing the right ventricle and pacing the left ventricle;

wherein the left ventricle is paced upon expiration of the atrio-ventricular escape interval; and

,

circuitry for stopping the atrio-ventricular escape interval upon occurrence of a right ventricular sense.

59. The device of claim 58 further comprising:

an electrode for sensing an atrium; and

,

circuitry for starting the atrio-ventricular escape interval upon occurrence of an atrial sense.

60. The device of claim 58 further comprising:

a sensing channel for sensing the left ventricle and generating a left ventricular sense upon detection of depolarization occurring in the left ventricle; and

,

circuitry for inhibiting the left ventricular pace if the pacing instant occurs within a protection period initiated by a left ventricular sense.