Apparatus and method for "LEPARS" interval-based fusion pacing
First Claim
1. A method of LV-only fusion pacing therapy delivery to a non-synchronous pair of ventricles, comprising:
- a) measuring an intrinsic P-R cardiac interval for a right ventricular (RV) chamber for at least one prior cardiac cycle;
b) decrementing the P-R interval to derive a nominal A-LVP interval;
c) delivering an LV-only pacing therapy using the nominal A-LVp interval and d) determining whether adequate ventricular fusion resulted, and in the event that adequate ventricular fusion resulted, then;
i) measuring a LEPARS interval by the amount of time elapsed between the delivery of the LV-only pacing therapy and a subsequent sensed depolarization of the RV; and
ii) delivering during a subsequent cardiac cycle at least one LV-only pacing therapy pulse to a left ventricular (LV) chamber, wherein said at least one LV-only pacing therapy pulse is delivered at the expiration of an A-LVp interval that preserves heart rate response requirements and substantially preserves the LEPARS interval; and
in the event that inadequate ventricular fusion failed to result, then;
modifying the A-LVp interval and repeating step c) through step d) above wherein the modified A-LVp interval is implemented in lieu of the nominal A-LVp interval.
1 Assignment
0 Petitions
Accused Products
Abstract
The present invention enables efficient provision of hemodynamic benefits and therapy for patients suffering from intraventricular conduction delays or conduction blockage. The invention enables effectively measures against conduction delay or block (e.g., left bundle branch block or “LBBB”) and enhances delivery of a novel form of left ventricle-only cardiac resynchronization therapy. According to the invention, a single LV fusion pacing stimulus is triggered from an atrial event (e.g., intrinsic or evoked depolarization). The triggering event can emanate from the right atrium (RA) or the left atrium (LA). The single LV fusion pacing stimulus is delivered prior to the intrinsic depolarization of the RV—upon expiration of a “LEPARS interval”—thus efficiently providing intraventricular electromechanical synchrony by fusion. During variations in heart rate the operating AV interval (herein A-LVp interval) is varied while the LEPARS interval substantially essentially constant, thereby preserving the enhanced hemodynamics resulting from the fusion depolarization.
43 Citations
51 Claims
-
1. A method of LV-only fusion pacing therapy delivery to a non-synchronous pair of ventricles, comprising:
-
a) measuring an intrinsic P-R cardiac interval for a right ventricular (RV) chamber for at least one prior cardiac cycle;
b) decrementing the P-R interval to derive a nominal A-LVP interval;
c) delivering an LV-only pacing therapy using the nominal A-LVp interval and d) determining whether adequate ventricular fusion resulted, and in the event that adequate ventricular fusion resulted, then;
i) measuring a LEPARS interval by the amount of time elapsed between the delivery of the LV-only pacing therapy and a subsequent sensed depolarization of the RV; and
ii) delivering during a subsequent cardiac cycle at least one LV-only pacing therapy pulse to a left ventricular (LV) chamber, wherein said at least one LV-only pacing therapy pulse is delivered at the expiration of an A-LVp interval that preserves heart rate response requirements and substantially preserves the LEPARS interval; and
in the event that inadequate ventricular fusion failed to result, then;
modifying the A-LVp interval and repeating step c) through step d) above wherein the modified A-LVp interval is implemented in lieu of the nominal A-LVp interval. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18)
-
-
19. An apparatus for delivering LV-only fusion-pacing therapy to promote mechanical synchrony between a right ventricular, (RV) chamber and a left ventricular (LV) chamber, comprising:
-
means for measuring an intrinsic atrio-ventricular delay interval for a right ventricular (RV) chamber for at least one prior cardiac cycle;
means for delivering during a subsequent cardiac cycle at least one pacing pulse to a LV chamber, wherein said at least pacing pulse is delivered at the expiration of an A-LVP interval, and wherein the intrinsic atrio-ventricular (P-R) interval is greater than said A-LVp interval; and
means for measuring and substantially maintaining a LEPARS interval during said LV-only fusion-pacing therapy delivery over a range of different paced heart rates. - View Dependent Claims (20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36)
-
-
37. A computer readable medium for storing instructions for performing a method, said method comprising delivering bi-ventricular, fusion-pacing therapy to one of a non-synchronous pair of ventricles, to promote mechanical synchrony between an intrinsically first-to-depolarize ventricular chamber and an intrinsically second-to-depolarize, ventricular chamber, comprising:
-
instructions for measuring an intrinsic atrio-ventricular delay interval for a first-to-depolarize ventricular chamber for at least one prior cardiac cycle; and
instructions for delivering during a subsequent cardiac cycle at least one ventricular pre-excitation pacing pulse to a second-to-depolarize ventricular chamber, wherein said at least one ventricular pre-excitation pacing pulse is delivered at the expiration of a ventricular pre-excitation interval, and wherein the intrinsic atrio-ventricular delay interval is greater than said ventricular pre-excitation interval. - View Dependent Claims (38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51)
-
Specification