Dual chamber pacing system and method utilizing detection of ventricular fusion for adjustment of the atrial-ventricular delay as therapy for hypertrophic obstructive cardiomyopathy
First Claim
1. A dual chamber pacemaker system, having atrial sense means for sensing atrial signals from a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient'"'"'s right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AVesc means for setting said AV escape interval, said AVesc means comprising:
- fusion means for detecting the occurrence of a fusion beat and the value AVfus of the AV escape interval corresponding to which a said fusion beat is detected, and program means for changing said AV escape interval so as to maintain said AVesc within a small range of values no greater than said value of AVfus, whereby pace pulses are delivered at an AV escape interval no greater than said AVfus.
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Accused Products
Abstract
A dual chamber pacemaker for providing ventricular pace pulses synchronized with atrial senses or paces, and having specific control for optimizing the AV escape interval and resultant AV delay for purposes of therapy for a patient with hypertrophic obstructive cardiomyopathy (HOCM). The pacemaker has an algorithm for varying the AV escape interval and detecting when the AV delay is lengthened to the point of evoking a fusion beat, thereby providing an accurate indication of a patient'"'"'s underlying PR interval without significant loss of pacing capture. By monitoring T-wave detection and drop in amplitude of the evoked T-wave, an algorithm is enabled for optimizing the pacemaker AV delay within a range of values just less than the longest value for obtaining pre-excitation by the delivered pace pulse.
195 Citations
18 Claims
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1. A dual chamber pacemaker system, having atrial sense means for sensing atrial signals from a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient'"'"'s right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AVesc means for setting said AV escape interval, said AVesc means comprising:
fusion means for detecting the occurrence of a fusion beat and the value AVfus of the AV escape interval corresponding to which a said fusion beat is detected, and program means for changing said AV escape interval so as to maintain said AVesc within a small range of values no greater than said value of AVfus, whereby pace pulses are delivered at an AV escape interval no greater than said AVfus. - View Dependent Claims (2, 3, 4)
- 5. A dual chamber pacemaker system, having atrial sense means for sensing atrial signals from a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient'"'"'s right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AVesc means for setting said AV escape interval, said AVesc means comprising fusion means for detecting the occurrence of a fusion beat and the value AVfus of the AV escape interval corresponding to which a said fusion beat is detected, storing means for storing said value of AVfus and program means for changing said AV escape interval as a function of said stored AVfus value.
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9. A dual chamber pacemaker having atrial sense means for sensing signals in a patient'"'"'s atrium, ventricular sense means for sensing signals in said patient'"'"'s ventricle, ventricular pace means for generating and delivering ventricular pace pulses to the patient'"'"'s ventricle, and AV control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, comprising:
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monitoring means for monitoring at least one of said signals sensed in said patient'"'"'s atrium and said patient'"'"'s ventricle and detecting therefrom when a delivered pace pulse causes a fusion beat; fusion means for determining the AV escape interval AVfus corresponding to a detected fusion beat; and adjusting means for adjusting said AV escape interval to a value less than said AVfus. - View Dependent Claims (10, 11, 12, 13, 14)
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15. A method of therapy for treating a patient with HOCM, said method utilizing a dual chamber pacemaker having atrial sense means for sensing atrial signals form a patient, ventricular sense means for sensing ventricular signals from a patient, ventricular pace means for generating and delivering ventricular pace pulses to said patient'"'"'s right ventricle, and sync control means for controlling said pace means to generate and deliver a ventricular pace pulse at a controlled AV escape interval following a sensed atrial signal, said sync control means having AVesc means for setting said AV escape interval, said method comprising:
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pacing said patient'"'"'s right ventricle with an AV escape interval shorter than the patient'"'"'s intrinsic PR conduction duration so as to provide complete capture with delivered pace pulses, detecting the occurrence of fusion beats by monitoring evoked T-waves and determining when the T-wave amplitude drops to a level indicative of a fusion, and following a said detected fusion beat adjusting said AV escape interval to a value less than the value which resulted in a fusion beat. - View Dependent Claims (16, 17, 18)
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Specification