Dual chamber pacing system and method with optimized adjustment of the AV escape interval for treating cardiomyopathy
First Claim
1. A dual chamber pacemaker system, having atrial sense means for sensing signals from a patient'"'"'s atrium, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pacing pulses to said patient'"'"'s right ventricle, AVesc means for setting and timing an AV escape interval from the occurrence of a sensed atrial signal, sync control means for controlling delivery of ventricular pacing pulses at the time out of said AV escape interval in the absence of a sensed ventricular signal, and FFRS means for detecting FFRSs following delivered ventricular pacing pulses, further comprising FFRS analyzing means for analyzing said detected FFRSs and determining therefrom an indication for adjustment of said AV escape interval, said AVesc means having adjusting means for adjusting said AV escape interval in accordance with said indication.
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Abstract
A dual chamber pacemaker system and method are provided for HOCM and like pacing therapy, with the feature of searching or scanning values of AV escape interval to define an optimized value at about the longest AV escape interval value consistent with full capture in response to a delivered ventricular pace pulse. In a preferred embodiment of the invention, the system and method sense and process FFRS signals derived from the atrial lead and otherwise, and obtain therefrom a characteristic which is evaluated for a determination of optimized AV escape interval. In one specific embodiment, the time durations between delivered ventricular pacing pulses and resulting FFRS signals are analyzed as a function of AV escape interval, and the optimized AV escape interval is chosen at about the longest AV escape interval corresponding to the longest such time duration, i.e., at about the knee of the FFRS time duration vs. AV escape interval curve. In another embodiment, the FFRS characteristic utilized is duration, and the system determines the longest AV escape interval corresponding to the highest duration value. The system and method can be utilized either with an external programmer or can be adapted to operate automatically in an implanted pacemaker.
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Citations
34 Claims
- 1. A dual chamber pacemaker system, having atrial sense means for sensing signals from a patient'"'"'s atrium, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pacing pulses to said patient'"'"'s right ventricle, AVesc means for setting and timing an AV escape interval from the occurrence of a sensed atrial signal, sync control means for controlling delivery of ventricular pacing pulses at the time out of said AV escape interval in the absence of a sensed ventricular signal, and FFRS means for detecting FFRSs following delivered ventricular pacing pulses, further comprising FFRS analyzing means for analyzing said detected FFRSs and determining therefrom an indication for adjustment of said AV escape interval, said AVesc means having adjusting means for adjusting said AV escape interval in accordance with said indication.
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15. A dual chamber pacemaker system, having atrial sense means for sensing signals from a patient'"'"'s atrium, atrial pace means for delivering atrial pacing pulses, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pacing pulses to said patient'"'"'s right ventricle, AVesc means for setting and timing out an AV escape interval from the occurrence of a sensed atrial signal or an atrial pacing pulse, and sync control means for controlling delivery of a ventricular pacing pulse at the time out of a said AV escape interval in the absence of a sensed ventricular signal, comprising
AV varying means for varying said AV escape interval in accord with a predetermined search pattern, measure means for detecting a measure of QRS waves evoked by a delivered ventricular pulse at said varied AV escape intervals, programmable batch data means for collecting data representative of respective QRS measure signals and corresponding values of AV escape interval, programmable analyzing means for analyzing said collected data to determine a value of AV escape interval corresponding to the onset of fusion, and said AV escape means having adjusting means for adjusting said AV escape interval as a function of said determined value of AV escape interval corresponding to the onset of fusion.
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25. A dual chamber pacemaker system, having atrial sense means for sensing signals from a patient'"'"'s atrium, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pacing pulses to said patient'"'"'s right ventricle, AVesc means for setting and timing out an AV escape interval from the occurrence of a sensed atrial signal, and sync control means for controlling delivery of a ventricular pacing pulse at the time out of a said AV escape interval in the absence of a sensed ventricular signal, comprising
scan means for controlling said AVesc means to vary said AV escape interval through successive values thereof, timing means for determining, corresponding to each scanned value of AV escape interval, a measure of the time duration between a delivered ventricular pacing pulse and a following evoked QRS, analyzing means for analyzing the said time duration measures to determine a value of AV escape interval corresponding optimal pre-excitation, and adjust means for adjusting the value of said AV escape interval in response to a determination of optimal pre-excitation.
- 31. A method of dual chamber synchronous pacing of a patient to provide CHF therapy, comprising detecting FFRS signals from said patient, processing said FFRS signals to obtain from them a predetermined characteristic thereof, analyzing said obtained characteristics to determine therefrom an indication of adjustment of the pacemaker AV escape interval and adjusting same in accordance with said indication, and then delivering ventricular pacing pulses to said patient at said adjusted AV escape interval following atrial events.
Specification