REDUCTION OF AV DELAY FOR TREATMENT OF CARDIAC DISEASE

• US 20080114407A1
• Filed: 12/22/2006
• Published: 05/15/2008
• Est. Priority Date: 11/13/2006
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Belalcazar, Andres, Spinelli, Julio C., Pastore, Joseph M., Shuros, Allan C., Salo, Rodney W.
• Granted Patent: US 8,019,416 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 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36535 controlled by body position or posture
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD

Abstract

An implantable pacing device for delivering ventricular pacing may be configured to intermittently reduce the AVD interval for beneficial effect in patients with compromised ventricular function (e.g., HF patients and post-MI patients). The AVD interval may be reduced in an AVD reduction mode, by shortening the AVD in an atrial triggered ventricular pacing mode or by switching to a non-atrial triggered ventricular pacing mode (e.g., VVI) and delivering paces at a rate above the intrinsic rate. The physiological effects of AVD reduction may be either positive or negative on cardiac output, depending upon the individual patient.

Claims

1. A cardiac device, comprising:

one or more ventricular pacing channels for delivering pacing pulses to one or more ventricular sites;

a controller programmed to operate the device in either a normal operating mode or AV delay reduction (AVDR) mode;

wherein, in the AVDR mode, the controller is programmed to deliver paces to the one or more ventricular sites using a pacing mode that decreases atrial preloading of the ventricles as compared with the normal operating mode; and

,

wherein the controller is programmed to intermittently switch from the normal operating mode to the AVDR mode according to a one or more specified entry conditions and switch from the AVDR mode to the normal operating mode according to one or more specified exit conditions.

2. The device of claim 1 wherein the AVDR mode includes pacing a ventricular site using a VVI pacing mode with a ventricular escape interval shorter than a patient'"'"'s intrinsic heart rate.

3. The device of claim 1 wherein the AVDR mode includes pacing a ventricular site using an atrial triggered pacing mode with an AV delay interval shorter than a patient'"'"'s intrinsic AV delay interval.

4. The device of claim 1 wherein one or more of the specified entry or exit conditions is a lapsed time interval to cause periodic switching to the AVDR mode.

5. The device of claim 1 further comprising means for measuring a patient'"'"'s exertion level and wherein the controller is programmed to operate in the AVDR mode only if the measured exertion level is within a specified range.

6. The device of claim 1 further comprising means for detecting pulmonary edema and wherein the controller is programmed to operate in the AVDR mode only if pulmonary edema is not detected.

7. The device of claim 1 further comprising means for detecting a patient'"'"'s posture and wherein the controller is programmed to not operate in the AVDR mode only if the patient is in a supine position.

8. The device of claim 1 further comprising means for measuring pulmonary arterial pressure and wherein the controller is programmed to operate in the AVDR mode only if pulmonary arterial pressure is within a specified range.

9. The device of claim 1 wherein one or more of the specified entry or exit conditions is a command to enter or exit the AVDR mode received via telemetry or a patient-operated switch.

10. The device of claim 1 wherein the controller is programmed to use different pacing channels in the AVDR mode than in the normal operating mode.

11. The device of claim 1 wherein the controller is programmed to deliver pacing through multiple ventricular pacing channels for each paced cycle, either simultaneously or with one or more specified offsets, during the AVDR mode.

12. The device of claim 1 wherein the controller is programmed to deliver pacing through multiple ventricular pacing channels during the AVDR mode, where the multiple ventricular pacing channels are rotated according to a defined schedule.

13. A method, comprising:

delivering pacing pulses to one or more ventricular sites in either a normal operating mode or AV delay reduction (AVDR) mode;

wherein, in the AVDR mode, paces are delivered to the one or more ventricular sites using a pacing mode that decreases atrial preloading of the ventricles as compared with the normal operating mode; and

,

intermittently switching from the normal operating mode to the AVDR mode according to a one or more specified entry conditions and switching from the AVDR mode to the normal operating mode according to one or more specified exit conditions.

14. The method of claim 13 wherein the AVDR mode includes pacing a ventricular site using a VVI pacing mode with a ventricular escape interval shorter than a patient'"'"'s intrinsic heart rate.

15. The method of claim 13 wherein the AVDR mode includes pacing a ventricular site using an atrial triggered pacing mode with an AV delay interval shorter than a patient'"'"'s intrinsic AV delay interval.

16. The method of claim 13 wherein one or more of the specified entry or exit conditions is a lapsed time interval to cause periodic switching to the AVDR mode.

17. The method of claim 13 further comprising measuring a patient'"'"'s exertion level and operating in the AVDR mode only if the measured exertion level is within a specified range.

18. The method of claim 13 further comprising using different pacing channels in the AVDR mode than in the normal operating mode.

19. The method of claim 13 further comprising delivering pacing through multiple ventricular pacing channels for each paced cycle, either simultaneously or with one or more specified offsets, during the AVDR mode.

20. The method of claim 13 further comprising delivering pacing through multiple ventricular pacing channels during the AVDR mode, where the multiple ventricular pacing channels are rotated according to a defined schedule.