SECURE AND EFFICACIOUS THERAPY DELIVERY FOR A PACING ENGINE

• US 20100152804A1
• Filed: 12/09/2009
• Published: 06/17/2010
• Est. Priority Date: 10/07/2003
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Duffin, Edwin G., Zhou, Ren, Euler, David E., Prieve, Kathleen A., Klepfer, Ruth N., Gillberg, Jeffrey M., Kleckner, Karen J., Deno, D. Curtis, Mulligan, Lawrence J., Burnes, John E., Zillmer, Glenn C., Anderson, Kenneth M., Splett, Vincent E., Igel, David A.
• Granted Patent: US 9,101,772 B2
• Time in Patent Office: Days
• US Class Current: 607/17
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• 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 1/36564 controlled by blood pressure
• CPC Class Codes: A61N 1/36578 controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone
• CPC Class Codes: A61N 1/36585 controlled by two or more physical parameters
• 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

The above-described methods and apparatus are believed to be of particular benefit for patients suffering heart failure including cardiac dysfunction, chronic HF, and the like and all variants as described herein and including those known to those of skill in the art to which the invention is directed. It will understood that the present invention offers the possibility of monitoring and therapy of a wide variety of acute and chronic cardiac dysfunctions. The current invention provides systems and methods for delivering therapy for cardiac hemodynamic dysfunction via the innervated myocardial substrate receives one or more discrete pulses of electrical stimulation during the refractory period of said innervated myocardial substrate.

Claims

1. A method of cardiac pacing, comprising:

sensing depolarizations of an atrium and a ventricle of a patient'"'"'s heart using an implantable cardiac pacemaker;

delivering atrial pacing pulses to the atrium of the patient'"'"'s heart using the pacemaker; and

at a selected time Tx following a sensed depolarization of the ventricle resulting from a preceding conducted atrial depolarization, delivering an atrial coupled (ACP) atrial pacing pulse;

wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state.

2. A method according to claim 1, wherein the preceding conducted atrial depolarization comprises a sensed atrial depolarization.

3. A method according to claim 2 further comprising delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.

4. A method according to claim 1, wherein the conducted atrial depolarization comprises a paced atrial depolarization.

5. A method according to claim 4 further comprising delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.

6. A method of cardiac pacing, comprising:

sensing depolarizations of an atrium and a ventricle of a patient'"'"'s heart using an implantable cardiac pacemaker;

delivering atrial pacing pulses to the atrium of the patient'"'"'s heart using the pacemaker; and

at a selected time Ty following a conducted depolarization of the atrium resulting in a sensed ventricular depolarization, delivering an atrial coupled (ACP) atrial pacing pulse;

wherein Ty is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state.

7. A method according to claim 6, wherein the conducted atrial depolarization comprises a sensed atrial depolarization.

8. A method according to claim 7 further comprising delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Ty is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.

9. A method according to claim 6, wherein the preceding conducted atrial depolarization comprises a paced atrial depolarization.

10. A method according to claim 9 further comprising delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Ty is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.

11. An implantable cardiac pacemaker, comprising:

means for sensing depolarizations of an atrium and a ventricle of a patient'"'"'s heart;

means for delivering atrial pacing pulses to the atrium of the patient'"'"'s heart; and

means for, at a selected time Tx following a sensed depolarization of the ventricle resulting from a preceding conducted atrial depolarization, delivering an atrial coupled (ACP) atrial pacing pulse;

wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state.

12. A pacemaker according to claim 11, wherein the preceding conducted atrial depolarization comprises a sensed atrial depolarization.

13. A pacemaker according to claim 12 further comprising means for delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.

14. A pacemaker according to claim 11, wherein the conducted atrial depolarization comprises a paced atrial depolarization.

15. A pacemaker according to claim 14 further comprising means for delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Tx is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.

16. An implantable cardiac pacemaker, comprising:

means for sensing depolarizations of an atrium and a ventricle of a patient'"'"'s heart;

means for delivering atrial pacing pulses to the atrium of the patient'"'"'s heart; and

means for, at a selected time Ty following a conducted depolarization of the atrium resulting in a sensed ventricular depolarization, delivering an ACP atrial pacing pulse;

wherein Ty is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state.

17. A pacemaker according to claim 16, wherein the conducted atrial depolarization comprises a sensed atrial depolarization.

18. A pacemaker according to claim 17 further comprising means for delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Ty is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.

19. A pacemaker according to claim 16, wherein the preceding conducted atrial depolarization comprises a paced atrial depolarization.

20. A pacemaker according to claim 99 further comprising means for delivering a pacing pulse to the ventricle following the sensed depolarization of the ventricle and wherein Ty is selected such that an atrial depolarization resulting from the delivered ACP atrial pacing pulse is not conducted to the ventricle because the ventricle is in a refractory state due to the delivered ventricular pacing pulse.