SYSTEM AND METHOD FOR CONDITIONAL BIVENTRICULAR PACING

• US 20100222839A1
• Filed: 02/26/2010
• Published: 09/02/2010
• Est. Priority Date: 02/27/2009
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Sweeney, Michael O.
• Granted Patent: US 8,396,553 B2
• Time in Patent Office: Days
• US Class Current: 607/17
• 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 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/3682 with a variable atrioventricular delay
• CPC Class Codes: A61N 1/3688 configured for switching the pacing mode, e.g. from AAI to DDD

Abstract

A medical device having a plurality of electrodes sensing cardiac signals, and a microprocessor operably coupled to the plurality of electrodes and configured to determine a cumulative atrioventricular interval (AVI) burden in response to the sensed cardiac signals, and to switch operation of the device between a minimal biventricular pacing (MBVP) mode and a conditional triple chamber pacing (CTCP) mode in response to the determined AVI burden.

Claims

1. A medical device, comprising:

a plurality of electrodes sensing cardiac signals; and

a microprocessor operably coupled to the plurality of electrodes and configured to determine a cumulative atrioventricular interval (AVI) burden in response to the sensed cardiac signals, and to switch operation of the device between a minimal biventricular pacing (MBVP) mode and a conditional triple chamber pacing (CTCP) mode in response to the determined AVI burden.

2. The device of claim 1, wherein the microprocessor determines first AVIs occurring during sinus rhythm and second AVIs occurring during delivery of atrial pacing therapy, and determines the cumulative AVI burden in response to the first and second AVIs.

3. The device of claim 2, wherein the microprocessor switches operation of the device between the MBVP mode to the CTCP mode in response to the cumulative AVI burden.

4. The device of claim 2, wherein the microprocessor determines times of day associated with the first AVIs and times of day associated with the second AVIs and determines the cumulative AVI burden in response to the determined times of day.

5. The device of claim 1, wherein the microprocessor determines existence of a high burden AVI circumstance in response to both the AVI burden being greater than an AVI burden threshold and atrial pacing delivered being greater than an atrial pacing threshold, and operates the device in the CTCP mode in response to the high burden circumstance being determined.

6. The device of claim 5, wherein the AVI burden threshold corresponds to a percentage of AV intervals having a predetermined length during a predetermined time period and the atrial pacing threshold corresponds to a percentage of average daily atrial pacing being applied during the predetermined time period.

7. The device of claim 6, wherein the microprocessor further determines the existence of the high burden circumstance in response to determining whether atrial pacing occurring during a predetermined condition is greater than a predetermined condition threshold.

8. The device of claim 7, wherein the predetermined condition corresponds to sleep, and wherein, in response to atrial pacing occurring during the predetermined condition being greater than the predetermined condition threshold, the microprocessor reduces an atrial pacing rate for a predetermined pacing time period, and determines the existence of the high burden circumstance in response to pacing being applied during the reduced atrial pacing rate being greater than the atrial pacing threshold.

9. The device of claim 8, wherein the AVI burden threshold corresponds to approximately 10 percent of AV intervals over a one week period being greater than 230 ms and the atrial pacing threshold corresponds to atrial pacing being applied more than approximately 15 percent on an averaged daily basis during the reduced pacing time period.

10. The device of claim 6, wherein the AVI burden threshold corresponds to approximately 10 percent of AV intervals over a one week period of time being between 250 and 260 ms.

11. The device of claim 1, wherein the microprocessor determines existence of a high burden AVI circumstance in response to both the AVI burden over a predetermined time period being greater than an AVI burden threshold and an amount of biventricular pacing being delivered when the device is in the MBVP mode being greater then a biventricular pacing threshold, and operates the device in the CTCP mode in response to the high burden circumstance being determined.

12. The device of claim 11, wherein the AVI burden threshold corresponds to approximately 10 percent of AV intervals over a one week period being greater than 230 ms and the biventricular pacing threshold corresponds to approximately 10 to 15 percent biventricular pacing when in the MBVP mode.

13. The device of claim 6, wherein the microprocessor omits determination of the high burden circumstance in response to atrial pacing being applied greater than an atrial pacing percentage threshold.

14. The device of claim 13, wherein the atrial pacing threshold corresponds to atrial pacing being applied approximately 80 percent of the time.

15. A method of operating a medical device, comprising:

sensing cardiac signals;

determining a cumulative atrioventricular interval (AVI) burden in response to the sensed cardiac signals; and

switching operation of the device between a minimal biventricular pacing (MBVP) mode and a conditional triple chamber pacing (CTCP) mode in response to the determined AVI burden.

16. The method of claim 15, wherein determining the cumulative AVI burden comprises:

determining first AVIs occurring during sinus rhythm and second AVIs occurring during delivery of atrial pacing therapy; and

determining the cumulative AVI burden in response to the first and second AVIs.

17. The method of claim 16, further comprising switching operation of the device between the MBVP mode to the CTCP mode in response to the cumulative AVI burden.

18. The method of claim 16, further comprising:

determining times of day associated with the first AVIs;

determining times of day associated with the second AVIs; and

determining the cumulative AVI burden in response to the determined times of day.

19. The method of claim 15, further comprising:

determining existence of a high burden AVI circumstance in response to both the AVI burden being greater than an AVI burden threshold and atrial pacing delivered being greater than an atrial pacing threshold; and

operating the device in the CTCP mode in response to the high burden circumstance being determined.

20. The method of claim 19, wherein the AVI burden threshold corresponds to a percentage of AV intervals having a predetermined length during a predetermined time period and the atrial pacing threshold corresponds to a percentage of average daily atrial pacing being applied during the predetermined time period.

21. The method of claim 20, further comprising determining the existence of the high burden circumstance in response to determining whether atrial pacing occurring during a predetermined condition is greater than a predetermined condition threshold.

22. The method of claim 21, wherein the predetermined condition corresponds to sleep, and further comprising:

reducing an atrial pacing rate for a predetermined pacing time period in response to atrial pacing occurring during the predetermined condition being greater than the predetermined condition threshold; and

determining the existence of the high burden circumstance in response to pacing being applied during the reduced atrial pacing rate being greater than the atrial pacing threshold.

23. The method of claim 22, wherein the AVI burden threshold corresponds to approximately 10 percent of AV intervals over a one week period being greater than 230 ms and the atrial pacing threshold corresponds to atrial pacing being applied more than approximately 15 percent on an averaged daily basis during the reduced pacing time period.

24. The method of claim 20, wherein the AVI burden threshold corresponds to approximately 10 percent of AV intervals over a one week period of time being between 250 and 260 ms.

25. The method of claim 15, further comprising:

determining existence of a high burden AVI circumstance in response to both the AVI burden over a predetermined time period being greater than an AVI burden threshold and an amount of biventricular pacing being delivered when the device is in the MBVP mode being greater then a biventricular pacing threshold; and

operating the device in the CTCP mode in response to the high burden circumstance being determined.

26. The method of claim 25, wherein the AVI burden threshold corresponds to approximately 10 percent of AV intervals over a one week period being greater than 230 ms and the biventricular pacing threshold corresponds to approximately 10 to 15 percent biventricular pacing when in the MBVP mode.

27. The method of claim 20, further comprising omitting determination of the high burden circumstance in response to atrial pacing being applied greater than an atrial pacing percentage threshold.

28. The method of claim 27, wherein the atrial pacing threshold corresponds to atrial pacing being applied approximately 80 percent of the time.