SYSTEM AND METHOD FOR DETERMINING INTRINSIC AV INTERVAL TIMING
First Claim
1. An implantable medical device, comprising:
- means for pacing at an atrial test rate;
means for sensing to determine if ventricular conduction occurs;
means for measuring the AV delay if conduction occurred;
means for recording the AV delay as corresponding to the test rate in the implantable medical device (IMD);
means for increasing the test rate by a predetermined increment and repeating the steps of sensing measuring and recording;
means for operating the IMD according to a ventricular pacing protocol (VPP);
means for sensing a premature ventricular contraction (PVC) in a first cardiac cycle;
means for measuring a duration of a first ventricular interval from a ventricular event immediately preceding the PVC to the PVC;
means for calculating a duration of a second ventricular interval to occur from the PVC to a target ventricular sensed event; and
means for modifying atrial timing in the first cardiac cycle to effect the second ventricular interval, wherein the modification to atrial timing is only made if data recorded in the memory indicates successful AV conduction at the modified atrial rate.
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Abstract
An atrial based pacing protocol promotes intrinsic conduction. An entire cardiac cycle is monitored for ventricular activity and permitted to lapse with ventricular activity. Ventricular pacing is available in a cardiac cycle immediately subsequent to such a skipped beat. When monitoring for intrinsic ventricular events, an event is expected within a given window. If no such event is detected, the cardiac cycle is truncated, leading to a shorter cycle that is devoid of ventricular activity. The subsequent cycle has a high likelihood of a ventricular sensed event and a greater than normal AV interval is provided prior to pacing.
99 Citations
19 Claims
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1. An implantable medical device, comprising:
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means for pacing at an atrial test rate; means for sensing to determine if ventricular conduction occurs; means for measuring the AV delay if conduction occurred; means for recording the AV delay as corresponding to the test rate in the implantable medical device (IMD); means for increasing the test rate by a predetermined increment and repeating the steps of sensing measuring and recording; means for operating the IMD according to a ventricular pacing protocol (VPP); means for sensing a premature ventricular contraction (PVC) in a first cardiac cycle; means for measuring a duration of a first ventricular interval from a ventricular event immediately preceding the PVC to the PVC; means for calculating a duration of a second ventricular interval to occur from the PVC to a target ventricular sensed event; and means for modifying atrial timing in the first cardiac cycle to effect the second ventricular interval, wherein the modification to atrial timing is only made if data recorded in the memory indicates successful AV conduction at the modified atrial rate. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10)
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11. An implantable medical device, comprising:
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an atrial pulse generator providing atrial pacing at atrial test rates; a ventricular sense amplifier responsive to occurrences of ventricular conduction following the pacing at atrial test rates; timing circuitry measuring the AV delay if conduction occurred following the pacing at atrial test rates; a recorder recording the measured AV delays as corresponding to the test rates in the implantable medical device (IMD); wherein the atrial pulse generator further provides atrial pacing at non-testing rates; wherein the ventricular sense amplifier is further responsive to premature ventricular contractions (PVCs) in given cardiac cycles during pacing at the non-testing rates; wherein the timing circuitry further measures a durations of first ventricular intervals extending between ventricular events immediately preceding the PVCs to the PVCs in the given cardiac cycles; control circuitry calculating a duration of a second ventricular intervals extending from the PVCs to desired ventricular sensed events; and control circuitry modifying the non-testing rates in the given cardiac cycles to effect the second ventricular interval, wherein the modification to atrial the non-testing rate is only made if data recorded in the device indicates AV conduction occurred at the test rate corresponding to the modified non-testing rate. - View Dependent Claims (12, 13, 14, 15, 16, 17, 18, 19)
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Specification