Tachycardia reversion pacer

• US 4,587,970 A
• Filed: 01/22/1985
• Issued: 05/13/1986
• Est. Priority Date: 01/22/1985
• Status: Expired due to Term

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Telectronics Incorporated
• Inventors: Holley, Loraine K., Evans, Robert
• Primary Examiner(s): Kamm, William E.
• Application Number:
  US06/693,592
• Time in Patent Office: 476 Days
• Field of Search: 128/419 PG, 128/419 PT
• US Class Current: 607/15
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions

Abstract

There is disclosed a tachycardia control pacer in which there is generated a sequence of pacing pulses at intervals which are a function of the effective refractory period intrinsically associated with the rate of the patient heartbeats. If the tachycardia episode is not terminated, another sequence of pulses is generated; however, the rate of the new sequence is decreased if at least one unevoked heartbeat was sensed during the preceding pacing pulse sequence and the rate is increased in the absence of any unevoked heartbeat having been sensed during the preceding pacing pulses sequence. Also, in order to smooth the transition between the fast pulses used to terminate the tachycardia episode and subsequent beating in sinus rhythm, pacing pulses continue to be generated at increasing pacing intervals until they merge into standby pacing.

Claims

1. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing and monitoring the rate of successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) determining a pacing interval as a predetermined function of the rate at which the patient heartbeats are occurring, said predetermined function being based upon the physiological relationship of effective refractory period and tachycardia rate, and

(c) generating a sequence of pacing pulses at intervals equal to said pacing interval in order to terminate said tachycardia episode, with the first pacing pulse of said sequence being generated following the last heartbeat used to confirm the tachycardia episode after the elapse of an interval which is equal to said pacing interval.

2. A method of operating a tachycardia control pacer in accordance with claim 1 wherein said pacing interval increases with a decreasing patient heartbeat rate but with a decreasing slope.

3. A method of operating a tachycardia control pacer in accordance with claim 2 wherein at relatively fast tachycardia rates the pacing interval is only slightly less than the intervals between heartbeats, and at relatively slow tachycardia rates the pacing interval is approximately half of the intervals between heartbeats.

4. A method of operating a tachycardia control pacer in accordance with claim 2 wherein the tachycardia control pacer has stored therein a table representing said predetermined function, and said pacing interval is determined in step (b) by a process of interpolation.

5. A method of operating a tachycardia control pacer in accordance with claim 4 wherein said predetermined function is empirically determined based upon experiments performed on a sample population.

6. A method of operating a tachycardia control pacer in accordance with claim 1 wherein said predetermined function is empirically determined based upon experiments performed on a sample population.

7. A method of operating a tachycardia control pacer in accordance with claim 6 wherein said experiments include the steps of (i) pacing a sample patient population at each of many rates, (ii) for each rate and for each patient, scanning the last pacing interval to determine the effective refractory interval for the respective patient-rate pair, (iii) averaging the data determined in step (ii) to compute a function of effective refractory period versus rate, and (iv) calculating said predetermined function by selecting a pacing interval for each rate which is slightly greater than the respective effective refractory period computed in step (iii) for the same rate.

8. A method of operating a tachycardia control pacer in accordance with claim 1 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is repeated but with an incremented pacing interval.

9. A method of operating a tachycardia control pacer in accordance with claim 8 wherein step (c) is repeated with an incremented pacing interval only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

10. A method of operating a tachycardia control pacer in accordance with claim 9 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted.

11. A method of operating a tachycardia control pacer in accordance with claim 8 wherein step (c) is repeated only after step (a) is first repeated to confirm that the tachycardia episode still exists and step (b) is also repeated to determine a new pacing interval, with the pacing interval used in the repeated step (c) being equal to the determined new pacing interval plus an increment.

12. A method of operating a tachycardia control pacer in accordance with claim 11 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted.

13. A method of operating a tachycardia control pacer in accordance with claim 1 further including the step of:

(d) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

14. A method of operating a tachycardia control pacer in accordance with claim 13 wherein step (a) is executed to determine whether the tachycardia episode still exists following the sensing of an unevoked heartbeat after the generation of at least one of the pacing pulses in the second sequence of step (d), and if the tachycardia episode still exists then repeating step (c) with a decremented pacing interval.

15. A method of operating a tachycardia control pacer in accordance with claim 14 wherein step (d) is aborted immediately and step (a) is executed responsive to the beating of the patient'"'"'s heart following the last pacing pulse within an interval which exceeds a prestored blanking interval but is less than a prestored standby interval.

16. A method of operating a tachycardia control pacer in accordance with claim 14 wherein, prior to the repeating of step (c), step (b) is first repeated to determine a new pacing interval, with the pacing interval used in the repeated step (c) being equal to the determined new pacing interval less a decrement.

17. A method of operating a tachycardia control pacer in accordance with claim 16 wherein step (d) is aborted immediately and steps (a) and (b) are executed responsive to the beating of the patient'"'"'s heart following the last pacing pulse within an interval which exceeds a prestored blanking interval but is less than a prestored standby interval.

18. A method of operating a tachycardia control pacer in accordance with claim 1 wherein the same electrode is used in steps (a) and (c).

19. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing and monitoring the rate of successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) determining a sequence of pacing pulses whose inter-pulse intervals are a predetermined function of the rate at which the patient heartbeats are occurring, said predetermined function being based upon the physiological relationship of effective refractory period and tachycardia rate, and

(c) generating said sequence of pacing pulses at the rate associated with said inter-pulse intervals.

20. A method of operating a tachycardia control pacer in accordance with claim 19 wherein the rate of said pacing pulse sequence decreases with a decreasing patient heartbeat rate and with a decreasing slope.

21. A method of operating a tachycardia control pacer in accordance with claim 20 wherein at relatively fast tachycardia rates the pacing pulse rate is only slightly greater than the heartbeat rate, and at relatively slow tachycardia rates the pacing pulse rate is approximately twice the heartbeat rate.

22. A method of operating a tachycardia control pacer in accordance with claim 20 wherein the tachycardia control pacer has stored therein a table representing said predetermined function, and said inter-pulse intervals are determined in step (b) by a process of interpolation.

23. A method of operating a tachycardia control pacer in accordance with claim 19 wherein said predetermined function is empirically determined based upon experiments performed on a sample population.

24. A method of operating a tachycardia control pacer in accordance with claim 23 wherein, said experiments include the steps of (i) pacing a sample patient population at each of many rates, (ii) for each rate and for each patient, scanning the last pacing interval to determine the effective refractory interval for the respective patient-rate pair, (iii) averaging the data determined in step (ii) to compute a function of effective refractory period versus rate, and (iv) calculating said predetermined function by selecting a pacing pulse rate for each experimental rate which is slightly less than the inverse of the respective effective refractory period computed in step (iii) for the same experimental rate.

25. A method of operating a tachycardia control pacer in accordance with claim 19 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is repeated but with a decremented pacing pulse rate.

26. A method of operating a tachycardia control pacer in accordance with claim 25, wherein step (c) is repeated with a slower pacing pulse rate only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

27. A method of operating a tachycardia control pacer in accordance with claim 26 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted.

28. A method of operating a tachycardia control pacer in accordance with claim 25 wherein step (c) is repeated only after step (a) is first repeated to confirm that the tachycardia episode still exists and step (b) is also repeated to determine a new pacing rate, with the pacing rate used in the repeated step (c) being slightly less than the determined new pacing rate.

29. A method of operating a tachycardia control pacer in accordance with claim 28 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted.

30. A method of operating a tachycardia control pacer in accordance with claim 19 further including the step of:

(d) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the rate continuously decreases.

31. A method of operating a tachycardia control pacer in accordance with claim 30 wherein step (a) is executed to determine whether the tachycardia episode still exists following the sensing of an unevoked heartbeat after the generation of at least one of the pacing pulses in the second sequence of step (d), and if the tachycardia episode still exists then repeating step (c) with an incremented pacing pulse rate.

32. A method of operating a tachycardia control pacer in accordance with claim 31 wherein step (d) is aborted immediately and step (a) is executed responsive to the beating of the patient'"'"'s heart following the last pacing pulse within an interval which exceeds a prestored blanking interval but is less than a prestored standby interval.

33. A method of operating a tachycardia control pacer in accordance with claim 31 wherein, prior to the repeating of step (c), step (b) is first repeated to determine a new pacing pulse rate, with the pacing pulse rate used in the repeated step (c) being slightly greater than the determined new pacing pulse rate.

34. A method of operating a tachycardia control pacer in accordance with claim 33 wherein step (d) is aborted immediately and steps (a) and (b) are executed responsive to the beating of the patient'"'"'s heart following the last pacing pulse within an interval which exceeds a prestored blanking interval but is less than a prestored standby interval.

35. A method of operating a tachycardia control pacer in accordance with claim 19 wherein the same electrode is used in steps (a) and (c).

36. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing and monitoring the rate of successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) determining a pacing interval which is a function of the rate at which the patient heartbeats are occurring,

(c) generating a sequence of pacing pulses at intervals equal to said pacing interval in order to terminate said tachycardia episode, with the first pacing pulse of said sequence being generated following the last heartbeat used to confirm the tachycardia episode after the elapse of an interval which is equal to said pacing interval, and

(d) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

37. A method of operating a tachycardia control pacer in accordance with claim 36, wherein step (d) is merged into standby pacing as the intervals between pacing pulses in said second sequence successively lengthen, and further including the steps of:

(e) sensing an unevoked heartbeat after the generation of at least one pacing pulse in the second sequence of step (d),

(f) in response to the sensing of an unevoked heartbeat in step (e), executing step (a) to determine whether the tachycardia episode still exists, and

(g) in response to determining in step (f) that the tachycardia episode still exists, repeating step (c) but with a decremented pacing interval.

38. A method of operating a tachycardia control pacer in accordance with claim 37 wherein step (d) is aborted and step (f) is executed immediately responsive to the sensing of a heartbeat in step (e).

39. A method of operating a tachycardia control pacer in accordance with claim 38, wherein, prior to the repeating of step (c), step (b) is first repeated to determine a new pacing interval, with the pacing interval used in the repeated step (c) being equal to the determined new pacing interval less a decrement.

40. A method of operating a tachycardia control pacer in accordance with claim 36 wherein said pacing interval of step (b) increases with a decreasing patient heartbeat rate but with a decreasing slope.

41. A method of operating a tachycardia control pacer in accordance with claim 40 wherein at relatively fast tachycardia rates the pacing interval is only slightly less than the intervals between heartbeats, and at relatively slow tachycardia rates the pacing interval is approximately half of the intervals between heartbeats.

42. A method of operating a tachycardia control pacer in accordance with claim 36 wherein said function of step (b) is predetermined, the tachycardia control pacer has stored therein a table representing said function, and said pacing interval is determined in step (b) by a process of interpolation.

43. A method of operating a tachycardia control pacer in accordance with claim 36 wherein said function of step (b) is empirically determined based upon experiments performed on a sample population.

44. A method of operating a tachycardia control pacer in accordance with claim 43 wherein said experiments include the steps of (i) pacing a sample patient population at each of many rates, (ii) for each rate and for each patient, scanning the last pacing interval to determine the effective refractory interval for the respective patient-rate pair, (iii) averaging the data determined in step (ii) to compute a function of effective refractory period versus rate, and (iv) calculating said function by selecting a pacing interval for each rate which is slightly greater than the respective effective refractory period computed in step (iii) for the same rate.

45. A method of operating a tachycardia control pacer in accordance with claim 36 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is repeated but with an incremented pacing interval.

46. A method of operating a tachycardia control pacer in accordance with claim 45 wherein step (c) is repeated with an incremented pacing interval only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

47. A method of operating a tachycardia control pacer in accordance with claim 45 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted.

48. A method of operating a tachycardia control pacer in accordance with claim 45 wherein step (c) is repeated only after step (a) is first repeated to confirm that the tachycardia episode still exists and step (b) is also repeated to determine a new pacing interval, with the pacing interval used in the repeated step (c) being equal to the determined new pacing interval plus an increment.

49. A method of operating a tachycardia control pacer in accordance with claim 48 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted.

50. A method of operating a tachycardia control pacer in accordance with claim 36 wherein the same electrode is used in steps (a) and (c).

51. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing and monitoring the rate of successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) generating a sequence of pacing pulses at intervals which are a function of the effective refractory period intrinsically associated with the rate of the heartbeats sensed in step (a), and

(c) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (b), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

52. A method of operating a tachycardia control pacer in accordance with claim 51 wherein step (c) is merged into standby pacing as the intervals between pacing pulses in said second sequence successively lengthen, and further including the steps of:

(d) sensing an unevoked heartbeat after the generation of at least one pacing pulse in the second sequence of step (c),

(e) in response to the sensing of an unevoked heartbeat in step (d), executing step (a) to determine whether the tachycardia episode still exists, and

(f) in response to determining in step (e) that the tachycardia episode still exists, repeating step (b) but with decremented pacing intervals.

53. A method of operating a tachycardia control pacer in accordance with claim 52 wherein step (c) is aborted and step (e) is executed immediately responsive to the sensing of a heartbeat in step (d).

54. A method of operating a tachycardia control pacer in accordance with claim 51 wherein said intervals of step (b) increase as a function of a decreasing patient heartbeat rate but with a decreasing slope.

55. A method of operating a tachycardia control pacer in accordance with claim 54 wherein at relatively fast tachycardia rates the intervals of step (b) are only slightly less than the intervals between heartbeats, and at relatively slow tachycardia rates the intervals of step (b) are approximately half of the intervals between heartbeats.

56. A method of operating a tachycardia control pacer in accordance with claim 51 wherein said function of step (b) is predetermined, the tachycardia control pacer has stored therein a table representing said function, and said pacing intervals are determined in step (b) by a process of interpolation.

57. A method of operating a tachycardia control pacer in accordance with claim 51 wherein said function of step (b) is empirically determined based upon experiments performed on a sample population.

58. A method of operating a tachycardia control pacer in accordance with claim 57 wherein said experiments include the steps of (i) pacing a sample patient population at each of many rates, (ii) for each rate and for each patient, scanning the last pacing interval to determine the effective refractory interval for the respective patient-rate pair, (iii) averaging the data determined in step (ii) to compute a function of effective refractory period versus rate, and (iv) calculating said function by selecting pacing intervals for each rate which are slightly greater than the respective effective refractory period computed in step (iii) for the same rate.

59. A method of operating a tachycardia control pacer in accordance with claim 51 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (b) is not an evoked response, step (b) is repeated but with incremented pacing intervals.

60. A method of operating a tachycardia control pacer in accordance with claim 59 wherein step (b) is repeated with incremented pacing intervals only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

61. A method of operating a tachycardia control pacer in accordance with claim 60 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (b) is not an evoked response, step (b) is immediately aborted.

62. A method of operating a tachycardia control pacer in accordance with claim 51 wherein the same electrode is used in steps (a) and (b).

63. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing successive patient heartbeats to confirm the existence of a tachycardia episode, and

(b) generating a sequence of pacing pulses at intervals which are a function of the effective refractory period intrinsically associated with the rate of the heartbeats sensed in step (a).

64. A method of operating a tachycardia control pacer in accordance with claim 63 further including the step of:

(c) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (b), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen so that they merge into standby pacing,

(d) sensing an unevoked heartbeat after the generation of at least one pacing pulse in the second sequence of step (c),

(e) in response to the sensing of an unevoked heartbeat in step (d), executing step (a) to determine whether the tachycardia episode still exists, and

(f) in response to determining in step (e) that the tachycardia episode still exists, repeating step (b) but with decremented pacing intervals.

65. A method of operating a tachycardia control pacer in accordance with claim 64 wherein step (c) is aborted and step (e) is executed immediately responsive to the sensing of a heartbeat in step (d).

66. A method of operating a tachycardia control pacer in accordance with claim 63 wherein said intervals of step (b) increase as a function of a decreasing patient heartbeat rate but with a decreasing slope.

67. A method of operating a tachycardia control pacer in accordance with claim 66 wherein at relatively fast tachycardia rates the intervals of step (b) are only slightly less than the intervals between heartbeats, and at relatively slow tachycardia rates the intervals of step (b) are approximately half of the intervals between heartbeats.

68. A method of operating a tachycardia control pacer in accordance with claim 63 wherein said function of step (b) is predetermined, the tachycardia control pacer has stored therein a table representing said function, and said pacing intervals are determined in step (b) by a process of interpolation.

69. A method of operating a tachycardia control pacer in accordance with claim 63 wherein said function of step (b) is empirically determined based upon experiments performed on a sample population.

70. A method of operating a tachycardia control pacer in accordance with claim 68 wherein said experiments include the steps of (i) pacing a sample patient population at each of many rates, (ii) for each rate and for each patient, scanning the last pacing interval to determine the effective refractory interval for the respective patient-rate pair, (iii) averaging the data determined in step (ii) to compute a function of effective refractory period versus rate, and (iv) calculating said function by selecting pacing intervals for each rate which are slightly greater than the respective effective refractory period computed in step (iii) for the same rate.

71. A method of operating a tachycardia control pacer in accordance with claim 63 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (b) is not an evoked response, step (b) is repeated but with incremented pacing intervals.

72. A method of operating a tachycardia control pacer in accordance with claim 71 wherein step (b) is repeated with incremented pacing intervals only after step (a) is repeated once again to conrirm that the tachycardia episode still exists.

73. A method of operating a tachycardia control pacer in accordance with claim 72 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (b) is not an evoked response, step (b) is immediately aborted.

74. A method of operating a tachycardia control pacer in accordance with claim 73 further including the step of:

(c) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (b), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen so that they merge into standby pacing,

(d) sensing an unevoked heartbeat after the generation of at least one pacing pulse in the second sequence of step (c),

(e) in response to the sensing of an unevoked heartbeat in step (d), executing step (a) to determine whether the tachycardia episode still exists, and

(f) in response to determining in step (e) that the tachycardia episode still exists, repeating step (b) but with decremented pacing intervals.

75. A method of operating a tachycardia control pacer in accordance with claim 74 wherein step (c) is aborted and step (e) is executed immediately responsive to the sensing of a heartbeat in step (d).

76. A method of operating a tachycardia control pacer in accordance with claim 72 further including the step of:

(c) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (b), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen so that they merge into standby pacing,

(d) sensing an unevoked heartbeat after the generation of at least one pacing pulse in the second sequence of step (c),

(e) in response to the sensing of an unevoked heartbeat in step (d), executing step (a) to determine whether the tachycardia episode still exists, and

(f) in response to determining in step (e) that the tachycardia episode still exists, repeating step (b) but with decremented pacing intervals.

77. A method of operating a tachycardia control pacer in accordance with claim 76 wherein step (c) is aborted and step (e) is executed immediately responsive to the sensing of a heartbeat in step (d).

78. A method of operating a tachycardia control pacer in accordance with claim 63 wherein the same electrode is used in steps (a) and (b).

79. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing and monitoring the rate of successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) determining a pacing interval which is a function of the rate at which the patient heartbeats are occurring,

(c) generating a sequence of pacing pulses at intervals equal to said pacing interval in order to terminate said tachycardia episode, with the first pacing pulse of said sequence being generated following the last heartbeat used to confirm the tachycardia episode after the elapse of an interval which is equal to said pacing interval, and

(d) repeating step (c) until the tachycardia episode is terminated but modifying the pacing interval used for each pacing pulse sequence by

(i) increasing it if at least one unevoked heartbeat is sensed during the preceding pacing pulse sequence, or

(ii) decreasing it in the absence of any unevoked heartbeat during the preceding pacing pulse sequence.

80. A method of operating a tachycardia control pacer in accordance with claim 79 wherein said pacing interval determined in step (b) increases with a decreasing patient heartbeat rate but with a decreasing slope.

81. A method of operating a tachycardia control pacer in accordance with claim 80 wherein at relatively fast tachycardia rates the pacing interval is only slightly less than the intervals betweeh heartbeats, and at relatively slow tachycardia rates the pacing interval is approximately half of the intervals between heartbeats.

82. A method of operating a tachycardia control pacer in accordance with claim 80 wherein the tachycardia control pacer has stored therein a table representing a predetermined function, and said pacing interval is determined in step (b) by a process of interpolation.

83. A method of operating a tachycardia control pacer in accordance with claim 79 wherein step (c) is repeated with an increased pacing interval only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

84. A method of operating a tachycardia control pacer in accordance with claim 79 wherein step (c) is repeated with a decreased pacing interval only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

85. A method of operating a tachycardia control pacer in accordance with claim 79 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted and step (d) is executed.

86. A method of operating a tachycardia control pacer in accordance with claim 79 wherein step (c) is repeated only after step (a) is first repeated to confirm that the tachycardia episode still exists and step (b) is also repeated to determine a new pacing interval, with the pacing interval used in the repeated step (c) being equal to the determined new pacing interval plus an increment or less a decrement.

87. A method of operating a tachycardia control pacer in accordance with claim 86 further including the step of:

(e) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

88. A method of operating a tachycardia control pacer in accordance with claim 87 wherein the same electrode is used in steps (a) and (c).

89. A method of operating a tachycardia control pacer in accordance with claim 79 further including the step of:

(e) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

90. A method of operating a tachycardia control pacer in accordance with claim 79 wherein the same electrode is used in steps (a) and (c).

91. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing and monitoring the rate of successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) determining a pacing rate which is a function of the rate at which the patient heartbeats are occurring,

(c) generating a sequence of pacing pulses at said pacing rate in order to terminate said tachycardia episode, and

(d) repeating step (c) until the tachycardia episode is terminated but modifying the pacing rate used for each pacing pulse sequence by

(i) decreasing it if at least one unevoked heartbeat is sensed during the preceding pacing pulse sequence, or

(ii) increasing it in the absence of any unevoked heartbeat during the preceding pacing pulse sequence.

92. A method of operating a tachycardia control pacer in accordance with claim 91 wherein said pacing rate determined in step (b) decreases with a decreasing patient heartbeat rate and with a decreasing slope.

93. A method of operating a tachycardia control pacer in accordance with claim 91 wherein the tachycardia control pacer has stored therein a table representing a predetermined function, and said pacing rate is determined in step (b) by a process of interpolation.

94. A method of operating a tachycardia control pacer in accordance with claim 91 wherein step (c) is repeated with a decreased pacing rate/only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

95. A method of operating a tachycardia control pacer in accordance with claim 94 wherein step (c) is repeated with an increased pacing rate only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

96. A method of operating a tachycardia control pacer in accordance with claim 91 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted and step (d) is executed.

97. A method of operating a tachycardia control pacer in accordance with claim 91 wherein step (c) is repeated only after step (a) is first repeated to confirm that the tachycardia episode still exists and step (b) is also repeated to determine a new pacing rate, with the pacing rate used in the repeated step (c) being equal to the determined new pacing rate plus an increment or less a decrement.

98. A method of operating a tachycardia control pacer in accordance with claim 97 further including the step of:

(e) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the pacing rate continuously decreases.

99. A method of operating a tachycardia control pacer in accordance with claim 91 further including the step of:

(e) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the pacing rate continuously decreases.

100. A method of operating a tachycardia control pacer in accordance with claim 91 wherein the same electrode is used in steps (a) and (c).

101. A method of operating a tachycardia control pacer comprising the steps of:

(a) monitoring the rate of successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) determining a pacing interval which is a function of the rate at which the patient heartbeats are occurring,

(c) generating a sequence of pacing pulses at intervals equal to said pacing interval in order to terminate said tachycardia episode, with the first pacing pulse of said sequence being generated following the last heartbeat used to confirm the tachycardia episode after the elapse of an interval which is equal to said pacing interval, and

(d) repeating step (c) until the tachycardia episode is terminated and preceding each repetition of step (c) by a repetition of step (b), but calculating successive pacing intervals for use in successive repetitions of step (c) by changing the pacing interval determined in step (b) by a predetermined amount.

102. A method of operating a tachycardia control pacer in accordance with claim 101 wherein each repetition of step (c) is preceded by a repetition of step (a) prior to the repetition of step (b).

103. A method of operating a tachycardia control pacer in accordance with claim 101 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted and step (d) is executed.

104. A method of operating a tachycardia control pacer in accordance with claim 101 wherein step (c) is repeated only after step (a) is first, repeated to confirm that the tachycardia episode still exists before step (b) is also repeated to determine a new pacing interval, with the pacing interval used in the repeated step (c) being equal to the determined new pacing interval changed by a predetermined amount.

105. A method of operating a tachycardia control pacer in accordance with claim 101 further including the step of:

(e) in the event no unevoked heartbeat is sensed during said sequence of pacing pulse generated in step (c), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

106. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) determining pacing intervals which are a function of the rate at which the patient heartbeats are occurring,

(c) generating a sequence of pacing pulses at the determined pacing intervals in order to terminate said tachycardia episode, and

(d) repeating step (c) until the tachycardia episode is terminated and preceding each repetition of step (c) by a repetition of step (b), but calculating successive pacing intervals for use in successive repetitions of step (c) by changing the pacing interval determined in step (b) by predetermined amounts.

107. A method of operating a tachycardia control pacer in accordance with claim 106 wherein each repetition of step (c) is preceded by a repetition of step (a) prior to the repetition of step (b).

108. A method of operating a tachycardia control pacer in accordance with claim 106 wherein if any heartbeat sensed during said sequence of pacing pulses generated in step (c) is not an evoked response, step (c) is immediately aborted and step (d) is executed.

109. A method of operating a tachycardia control pacer in accordance with claim 106 wherein step (c) is repeated only after step (a) is first repeated to confirm that the tachycardia episode still exists before step (b) is also repeated to determine new pacing intervals, with the pacing intervals used in the repeated step (c) being equal to the determined new pacing intervals changed by a predetermined amount.

110. A method of operating a tachycardia control pacer in accordance with claim 106 further including the step of:

(e) in the event no unevoked heartbeat is sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

111. A method of operating a tachycardia control pacer comprising the steps of:

(a) sensing successive patient heartbeats to confirm the existence of a tachycardia episode,

(b) determining pacing intervals which are a function of the rate at which the patient heartbeats are occurring,

(c) generating a sequence of pacing pulses at the determined pacing intervals in order to terminate said tachycardia episode,

(d) blanking the sensing of patient heartbeats for a predetermined interval following the generation of each pacing pulse in step (c), and

(e) responsive to the sensing of a patient heartbeat during the execution of step (c), repeating step (c) but with longer pacing intervals.

112. A method of operating a tachycardia control pacer in accordance with claim 111 wherein said function is predetermined and empirically determined based upon experiments performed on a sample population.

113. A method of operating a tachycardia control pacer in accordance with claim 112 wherein said experiments include the steps of (i) pacing a sample patient population at each of many rates, (ii) for each rate and for each patient, scanning the last pacing interval to determine the effective refractory interval for the respective patient-rate pair, (iii) averaging the data determined in step (ii) to compute a function of effective refractory period versus rate, and (iv) calculating said predetermined function by selecting pacing intervals for each rate which are slightly greater than the respective effective refractory period computed in step (iii) for the same rate.

114. A method of operating a tachycardia control pacer in accordance with claim 111 wherein step (c) is repeated with longer pacing intervals only after step (a) is repeated once again to confirm that the tachycardia episode still exists.

115. A method of operating a tachycardia control pacer in accordance with claim 111 wherein step (c) is repeated only after step (a) is first repeated to confirm that the tachycardia episode still exists and step (b) is also repeated to determine new pacing intervals, with the pacing intervals used in the repeated step (c) being equal to the determined new pacing intervals plus an increment.

116. A method of operating a tachycardia control pacer in accordance with claim 115 further including the step of:

(f) in the event a patient heartbeat is not sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

117. A method of operating a tachycardia control pacer in accordance with claim 116 wherein step (a) is executed to determine whether the tachycardia episode still exists following the sensing of a patient heartbeat after the generation of at least one of the pacing pulses in the second sequence of step (f), and if the tachycardia episode still exists then repeating step (c) with shorter pacing intervals.

118. A method of operating a tachycardia control pacer in accordance with claim 117 wherein, prior to the repeating of step (c), following step (f), step (b) is first repeated to determine new pacing intervals, with the pacing intervals used in the repeated step (c) being equal to the determined new pacing intervals less a decrement.

119. A method of operating a tachycardia control pacer in accordance with claim 111 further including the step of:

(f) in the event a patient heartbeat is not sensed during said sequence of pacing pulses generated in step (c), generating a second sequence of pacing pulses in which the intervals between successive pulses successively lengthen.

120. A method of operating a tachycardia control pacer in accordance with claim 119 wherein step (a) is executed to determine whether the tachycardia episode still exists following the sensing of a patient heartbeat after the generation of at least one of the pacing pulses in the second sequence of step (f), and if the tachycardia episode still exists then repeating step (c) with shorter pacing intervals.

121. A method of operating a tachycardia control pacer in accordance with claim 120 wherein, prior to the repeating of step (c), following step (f), step (b) is first repeated to determine new pacing intervals, with the pacing intervals used in the repeated step (c) being equal to the determined new pacing intervals less a decrement.

122. A method of operating a tachycardia control pacer in accordance with claim 111 wherein the same electrode is used in steps (a) and (c).