Dual chamber heart pacer with improved ventricular rate control
First Claim
1. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a mesurement interval which is sufficiently long to allow an average value to be determined; and
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, for controlling said ventricular pulse generating means to operate at a constant rate independent of said atrial beat sensing means when said atrial rate is above said predetermined atrial upper rate, and for controlling the operating rate of said ventricular pulse generating means to decrease gradually toward said constant rate following said atrial rate first rising above said predetermined atrial upper rate.
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Accused Products
Abstract
A dual-chamber heart pacer whose ventricular pacing rate is closely matched to the physiological requirements of the patient. A "true" atrial rate is determined by counting over a 3-second interval the number of sensed atrial beats, including those which occur during atrial refractory periods. When the atrial rate rises to a threshold level, the ventricular pacing rate decreases gradually from the Wenckebach rate to a fall-back rate independent of atrial sensing. During this decline, atrial pacing pulses may be generated simultaneously with ventricular pacing pulses in an effort to terminate tachycardia. The controlled decline in ventricular pacing rate begins after a 3:2 block has resulted, but before a 2:1 block would otherwise result. The fall-back rate is higher than the standby rate to compensate for the lack of atrial pacing when the system operates at the fall-back rate.
74 Citations
119 Claims
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1. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a mesurement interval which is sufficiently long to allow an average value to be determined; and
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, for controlling said ventricular pulse generating means to operate at a constant rate independent of said atrial beat sensing means when said atrial rate is above said predetermined atrial upper rate, and for controlling the operating rate of said ventricular pulse generating means to decrease gradually toward said constant rate following said atrial rate first rising above said predetermined atrial upper rate. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29)
- means for generating ventricular pacing pulses;
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30. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a measurement interval which is sufficiently long to allow an average value to be determined; and
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, for controlling said ventricular pulse generating means to operate at a constant rate independent of said atrial beat sensing means when said atrial rate is above said predetermined atrial upper rate, and for limiting the minimum operating rate of said ventricular pulse generating means to a standby value, said constant rate being higher than said standby value.
- means for generating ventricular pacing pulses;
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31. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a measurement interval which is sufficiently long to allow an average value to be determined;
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, and for controlling said ventricular pulse generating means to operate at a constant rate independent of said atrial beat sensing means when said atrial rate is above said predetermined atrial upper rate; and
means under external control for setting said predetermined atrial upper rate.
- means for generating ventricular pacing pulses;
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32. A heart pacer comrising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a measurement interval which is sufficiently long to allow an average value to be determined;
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, and for controlling said ventricular pulse generating means to operate at a constant rate independent of said atrial beat sensing means when said atrial rate is above said predetermined atrial upper rate;
means for sensing ventricular beats;
means for generating atrial pacing pulses;
means for syncrhonizing the operation of said atrial pulse generating means to the operation of said ventricular beat sensing means; and
means for inhibiting operation of said atrial pulse generating means when said ventricular pulse generating means operates at said constant rate.
- means for generating ventricular pacing pulses;
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33. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a measurement interval which is sufficiently long to allow an average value to be determined; and
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, and for controlling said ventricular pulse generating means to operate at a constant rate independent of said atrial beat sensing means when said atrial rate is above said predetermined atrial upper rate;
wherein said controlling means, in controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means, ignores the sensing of any atrial beat which occurs during a refractory period which follows an operation of said ventricular pulse generating means.
- means for generating ventricular pacing pulses;
-
34. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a measurement interval which is sufficiently long to allow an average value to be determined; and
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, and for controlling said ventricular pulse generating means to operate at a constant rate independent of said atrial beat sensing means when said atrial rate is above said predetermined atrial upper rate;
wherein said atrial rate determining means includes in its determination of atrial rate an atrial beat which is sensed during said refractory period. - View Dependent Claims (35)
- means for generating ventricular pacing pulses;
-
36. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate; and
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, and for controlling the operating rate of said ventricular pulse generating means to decrease over at least several seconds to a constant rate independent of said atrial beat sensing means when said atrial rate rises above said predetermined atrial upper rate. - View Dependent Claims (37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66)
- means for generating ventricular pacing pulses;
-
67. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate; and
means for controlling said ventricular pulse generating means to operate in synchronism with said atrial beat sensing means when said atrial rate is below a predetermined atrial upper rate, and for controlling the operating rate of said ventricular pulse generating means to decrease over at least several cycles of operation to a constant rate independent of said atrial beat sensing means when said atrial rate rises above said predetermined atrial upper rate. - View Dependent Claims (68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82)
- means for generating ventricular pacing pulses;
-
83. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a measurement interval which is sufficiently long to allow an average value to be determined;
means for controlling the mode in which said ventricular pulse generating means operates relative to the operation of said atrial beat sensing means dependent upon whether said atrial rate is above or below an atrial upper rate;
said ventricular pulse generating means having its operation synchronized to that of said atrial beat sensing means in at least one mode in which the sensing of any atrial beat which occurs during a refractory period which follows an operation of said ventricular pulse generating means is ignored;
said atrial rate determining means including in its determination of atrial rate an atrial beat which is sensed during said refractory period;
means for sensing ventricular beats; and
means for preventing said atrial rate determining means from including in its determination of atrial rate any sensed atrial beat which precedes a sensed ventricular beat by less than a predetermined interval. - View Dependent Claims (84, 85, 86, 87, 88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99, 100)
- means for generating ventricular pacing pulses;
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101. A heart pacer comprising means for sensing atrial beats;
- means for generating ventricular pacing pulses;
means responsive to said atrial beat sensing means for determining the atrial rate as a function of the number of atrial beats which occur during a measurement interval which is sufficiently long to allow an average value to be determined as opposed to an atrial rate which is a function of only the single interval between two successive atrial beats; and
means for controlling the mode in which said ventricular pulse generating means operates relative to the operation of said atrial beat sensing means dependent upon whether said atrial rate is above or below an atrial upper rate;
said ventricular pulse generating means having its operation synchronized to that of said atrial beat sensing means in at least one mode in which the sensing of any atrial beat which occurs during a refractory period which follows an operation of said ventricular pulse generating means is ignored;
said atrial rate determining means including in its determination of atrial rate an atrial beat which is sensed during said refractory period. - View Dependent Claims (102, 103, 104, 105, 106, 107, 108, 109, 110, 111, 112, 113, 114, 115, 116, 117, 118, 119)
- means for generating ventricular pacing pulses;
Specification