Automatic modulation of pacing timing intervals using beat to beat measures

• US 20080275520A1
• Filed: 05/03/2007
• Published: 11/06/2008
• Est. Priority Date: 05/03/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Carlson, Gerrard M., Yu, Yinghong, Hopper, Donald L., Arcot-Krishnamurthy, Shantha, Shuros, Allan Charles, Stahmann, Jeffrey
• Granted Patent: US 8,103,343 B2
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• 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

Abstract

Methods and systems to modulate timing intervals for pacing therapy are described. For each cardiac cycle, one or both of an atrioventricular (A-V) timing interval and an atrial (A-A) timing interval are modulated to oppose beat-to-beat ventricular (V-V) timing variability. Pacing therapy is delivered using the modulated timing intervals.

Claims

1. A method of delivering pacing therapy to a heart, comprising:

for each cardiac cycle, independently modulating one or both of an atrioventricular (A-V) timing interval and an atrial (A-A) timing interval to oppose beat-to-beat ventricular (V-V) variability; and

delivering the pacing therapy using the modulated timing intervals.

2. The method of claim 1, further comprising:

determining an indicated pacing rate based on physiological status; and

wherein independently modulating the timing intervals comprises independently modulating the timing intervals of the indicated pacing rate.

3. The method of claim 2, wherein determining the indicated pacing rate based on the physiological status comprises determining the indicated pacing rate based on one or more of metabolic need, autonomic tone, and hemodynamic status.

4. The method of claim 1, further comprising modulating on or more of an interventricular delay interval, an intraventricular delay interval, an interatrial delay interval, and an intraatrial delay interval.

5. The method of claim 1, wherein independently modulating the timing intervals comprises independently modulating the timing intervals based on respiration cycle phase.

6. The method of claim 1, wherein independently modulating the timing intervals comprises providing rate dependent modulation the timing intervals to produce optimal stroke volume for each beat.

7. The method of claim 1, wherein independently modulating the timing intervals comprises independently modulating at least one pacing interval initially determined by an algorithm to optimize heart failure therapy.

8. The method of claim 1, wherein a degree of the modulation is based on one or both of exertion level and heart rate.

9. The method of claim 1, wherein independently modulating the timing intervals comprises independently modulating the timing intervals based on one or more of blood pressure, blood flow, baroreflex and chemoreflex.

10. The method of claim 1, wherein independently modulating the timing intervals of the indicated pacing rate comprises independently modulating the timing intervals based on cardiac contractility.

11. The method of claim 1, wherein independently modulating the timing intervals comprises decreasing beat-to-beat V-V variability as heart rate increases.

12. The method of claim 1, further comprising:

sensing a physiological parameter of a right heart chamber during a cardiac cycle; and

independently modulating the timing intervals for a next cardiac cycle based on the sensed right heart chamber parameter.

13. The method of claim 1, wherein independently modulating the timing intervals comprises modulating an atrioventricular interval and interventricular delay interval to provide cardiac resynchronization therapy.

14. A cardiac rhythm management device, comprising:

a sensor system including one or more sensors configured to sense one or more physiological parameters;

a therapy control processor configured to independently modulate, for each cardiac cycle, one or more of atrial (A-A) timing interval and an atrioventricular (A-V) timing interval to oppose ventricular (V-V) variability based on the sensed physiological parameters; and

a therapy delivery system configured to deliver pacing to a heart using the independently modulated timing intervals.

15. The device of claim 14, wherein:

the sensor system includes a respiration sensor; and

the therapy control processor is configured to determine the respiration cycle phase and to modulate the pacing timing intervals based on respiration cycle phase.

16. The device of claim 14, wherein:

the therapy control processor is configured to control delivery of non-excitory electrical stimulation to alter myocardial contractility; and

the therapy delivery system is configured to deliver the non-excitory electrical stimulation under control of the therapy control processor.

17. The device of claim 14, wherein the therapy control processor is configured to modulate the A-A and A-V timing intervals to cancel fluctuations in the V-V intervals within one beat at elevated heart rates.

18. The device of claim 14, wherein the therapy control processor is further configured to modulate one or more of an interventricular timing interval, an intraventricular timing interval, an interatrial timing interval, and an intraatrial timing interval.

19. The device of claim 14 wherein:

the sensor system is configured to sense a physiological parameter of a right heart chamber during a cardiac cycle; and

the therapy control processor is configured to independently modulate the timing intervals of the indicated pacing rate for a next cardiac cycle based on the sensed right heart chamber parameter.

20. The device of claim 14, wherein the therapy control processor is configured to provide rate dependent modulation of the pacing timing intervals to produce optimal stroke volume for each cardiac beat at elevated heart rates.

21. A cardiac rhythm management system, comprising:

means for independently modulating timing intervals for each cardiac cycle, including modulating atrial (A-A) and atrioventricular (A-V) timing intervals to oppose ventricular (V-V) variability; and

therapy circuitry configured to deliver pacing therapy using the modulated timing intervals.

22. The system of claim 21, further comprising means for independently modulating the timing intervals based on respiration cycle phase.

23. The system of claim 21, further comprising means for independently modulating one or both of an A-V interval and an A-A interval to stabilize beat-to-beat V-V variability at elevated heart rates.

24. The system of claim 21, further comprising:

means for sensing a physiological parameter of a right heart chamber during a cardiac cycle; and

means for independently modulating the timing intervals for a next cardiac cycle based on the sensed right heart chamber parameter.

25. The system of claim 21, further comprising means for modulating at least one of the atrioventricular timing interval and an interventricular delay interval to provide cardiac resynchronization therapy.