PREDICTING CHRONIC OPTIMAL A-V INTERVALS FOR BIVENTRICULAR PACING VIA OBSERVED INTER-ATRIAL DELAY
First Claim
1. A method for programming an atrio-ventricular (A-V) delay interval for a bi-ventricular implantable pulse generator, comprising:
- determining an inter-atrial conduction time (IACT) between an evoked depolarization of a right atrium (RA) and a conducted depolarization of a left atrium (LA);
calculating an atrio-ventricular (AV) delay interval based upon the IACT; and
subsequently delivering for at least one cardiac cycle a bi-ventricular pacing therapy to a right ventricle (RV) and to a left ventricle (LV) upon expiration of the calculated AV delay interval.
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Abstract
Herein provided are methods for optimizing the atrio-ventricular (A-V) delay for efficacious delivery of cardiac resynchronization therapy. The A-V delay is set such that pacing-induced left ventricular contraction occurs following completion of left atrial (LA) contraction. This maximizes left ventricular filling (preload) which theoretically results in optimal LV contraction via the Frank-Starling mechanism. In CRT devices, the programmed A-V delay starts with detection of electrical activity in the right atrium (RA). Thus, a major component of the A-V delay is the time required for inter-atrial conduction time (IACT) from the RA to the LA. This IACT can be measured during implantation as the time from the atrial lead stimulation artifact to local electrograms in a coronary sinus (CS) catheter. Assuming that the beginning of LA contraction closely corresponds with the beginning of LA electrical activity, the optimal AV delay should be related to the time between the start of RA electrical activity and the start of LA electrical activity plus the duration of LA atrial contraction. Thus the inventors hypothesized that during atrial pacing the IACT measured at implantation correlated with the echocardiographically defined optimal paced AV delay (PAV).
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Citations
20 Claims
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1. A method for programming an atrio-ventricular (A-V) delay interval for a bi-ventricular implantable pulse generator, comprising:
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determining an inter-atrial conduction time (IACT) between an evoked depolarization of a right atrium (RA) and a conducted depolarization of a left atrium (LA); calculating an atrio-ventricular (AV) delay interval based upon the IACT; and subsequently delivering for at least one cardiac cycle a bi-ventricular pacing therapy to a right ventricle (RV) and to a left ventricle (LV) upon expiration of the calculated AV delay interval. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8)
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9. An apparatus for programming an atrio-ventricular (A-V) delay interval for a bi-ventricular implantable pulse generator, comprising:
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means for determining an inter-atrial conduction time (IACT) between an evoked depolarization of a right atrium (RA) and a conducted depolarization of a left atrium (LA); means for calculating an atrio-ventricular (AV) delay interval based upon the IACT; and means for subsequently delivering for at least one cardiac cycle a bi-ventricular pacing therapy to a right ventricle (RV) and to a left ventricle (LV) upon expiration of the calculated AV delay interval. - View Dependent Claims (10, 11, 12, 13, 14, 15, 16, 20)
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17. A computer readable medium for storing executable instructions for performing a method of programming an atrio-ventricular (A-V) delay interval for a bi-ventricular implantable pulse generator, comprising:
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instructions for determining an inter-atrial conduction time (IACT) between an evoked depolarization of a right atrium (RA) and a conducted depolarization of a left atrium (LA); instructions for calculating an atrio-ventricular (AV) delay interval based upon the IACT; and instructions for subsequently delivering for at least one cardiac cycle a bi-ventricular pacing therapy to a right ventricle (RV) and to a left ventricle (LV) upon expiration of the calculated AV delay interval. - View Dependent Claims (18, 19)
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Specification