Methods and Systems for Mitigating the Occurrence of Arrhythmia During Atrial Pacing
First Claim
1. A method of operating an implantable cardiac rhythm device to deliver pacing to an atrium, the method, comprising:
- delivering atrial pacing;
using a post ventricular refractory period (PVARP) having a first PVARP duration during cardiac cycles of the atrial pacing in which an atrial pace captures the atrium;
using an A-A interval having a first A-A interval duration between cardiac cycles of the atrial pacing in which the atrial pace captures the atrium; and
using a PVARP having a second PVARP duration and using an A-A interval having a second A-A interval duration during cardiac cycles of the atrial pacing in which the atrial pace does not capture the atrium, wherein the second PVARP duration is greater than the first duration PVARP and the second A-A interval duration is greater than the first A-A interval duration.
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Abstract
Noncaptured atrial paces can result in long-short cardiac cycles which are proarrhythmic for ventricular tachyarrhythmia. Approaches are described which are directed to avoiding proarrhythmic long-short cycles. For cardiac cycles in which the atrial pace captures the atrium, a first post ventricular refractory period (PVARP) and a first A-A interval are used. For cardiac cycles in which the atrial pace does not capture the atrium, both an extended PVARP and an extended A-A interval are used. The A-A interval following a noncaptured atrial pace is extended from an atrial depolarization sensed during the extended PVARP.
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Citations
18 Claims
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1. A method of operating an implantable cardiac rhythm device to deliver pacing to an atrium, the method, comprising:
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delivering atrial pacing; using a post ventricular refractory period (PVARP) having a first PVARP duration during cardiac cycles of the atrial pacing in which an atrial pace captures the atrium; using an A-A interval having a first A-A interval duration between cardiac cycles of the atrial pacing in which the atrial pace captures the atrium; and using a PVARP having a second PVARP duration and using an A-A interval having a second A-A interval duration during cardiac cycles of the atrial pacing in which the atrial pace does not capture the atrium, wherein the second PVARP duration is greater than the first duration PVARP and the second A-A interval duration is greater than the first A-A interval duration. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. An implantable cardiac therapy device, comprising:
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electrodes configured to be electrically coupled to an atrium; a pulse generator configured to deliver atrial pacing pulses to the atrium; a cardiac response classification processor configured to discriminate noncaptured responses to the atrial pacing pulses from other cardiac responses to the atrial pacing pulses; and a pacing control module configured to control delivery of the pacing pulses and timing intervals used during pacing cycles, the pacing control module configured to use a post ventricular refractory period (PVARP) having a first duration during cardiac cycles in which an atrial pace captures the atrium, to use an A-A interval having a first A-A interval duration between cardiac cycles during cardiac cycles in which the atrial pace captures the atrium, and to use PVARP having a second PVARP duration and an A-A interval having a second A-A interval duration during cardiac cycles in which the atrial pace does not capture the atrium, wherein the second PVARP duration is greater than the first PVARP duration and the second A-A interval duration is greater than the first A-A interval duration. - View Dependent Claims (9, 10, 11, 12, 13)
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14. A method of operating an implantable cardiac rhythm device, comprising:
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delivering an atrial pace to the atrium during a cardiac cycle; scheduling a ventricular pace to occur during the cardiac cycle after an atrioventricular (AV) delay; sensing for a cardiac response to the atrial pace during an evoked response interval that follows delivery of the atrial pace; determining if the cardiac response is noncapture based on the sensing during the evoked response interval; and in response to determining that the cardiac response to the atrial pace is noncapture based on the sensing during the evoked response interval; delivering an atrial backup pace having an energy sufficient to effect capture of the atrium; canceling the scheduled ventricular pace; extending a duration of the AV delay or initiating a second AV delay; and delivering a ventricular pace after the extended duration AV delay or the second AV delay. - View Dependent Claims (15, 16, 17)
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18. A method of operating an implantable cardiac rhythm device to deliver pacing to an atrium, the method, comprising:
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delivering an atrial pace to the atrium during a cardiac cycle; scheduling a ventricular pace to occur during the cardiac cycle after an atrioventricular (AV) delay; sensing for a cardiac response to the atrial pace during an evoked response interval that follows delivery of the atrial pace; determining that the cardiac response is not noncapture based on the cardiac response sensed during the evoked response interval; and in response to determining that the cardiac response to the atrial pace is not noncapture; delivering an atrial backup pace having an energy sufficient to effect capture of the atrium; canceling the scheduled ventricular pace; decreasing the AV delay; and delivering a ventricular pace after the decreased AV delay.
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Specification