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Method and apparatus for optimizing pacemaker AV delay

  • US 5,626,623 A
  • Filed: 04/30/1996
  • Issued: 05/06/1997
  • Est. Priority Date: 04/30/1996
  • Status: Expired due to Term
First Claim
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1. In a dual chamber pacemaker pulse generator operating in accordance with an atrial-ventricular (AV) synchronous pacing method comprising the steps of:

  • timing a ventricular-atrial (V-A) pacing escape interval from a paced ventricular event;

    delivering an atrial pace pulse to an atrium of a patient'"'"'s heart at the time out of the V-A pacing escape interval unless an atrial sensed event occurs within said pacing escape interval;

    prematurely terminating the V-A pacing escape interval on the sensing of an atrial sensed event within said V-A pacing escape interval;

    timing an AV delay interval starting from a sensed atrial event or delivery of an atrial pace pulse;

    delivering a ventricular pace pulse to a ventricle of the patient'"'"'s heart at the termination of the AV delay interval unless a ventricular sensed event occurs within the AV delay interval;

    prematurely terminating the AV delay interval on the sensing of a ventricular sensed event within the AV delay interval; and

    restarting the V-A pacing escape interval on a ventricular pace pulse or a ventricular sensed event,an AV delay interval optimization method for establishing an optimum AV delay interval for optimal left heart AV mechanical synchrony and function operable in conjunction with the AV synchronous pacing method steps comprising the further optimization method steps of;

    (a) determining a stable atrial heart rate;

    (b) on determination of a stable heart rate in step (a), continuing with steps (c)-(i) with an initial test AV delay interval;

    (c) in the time period following a ventricular pace pulse delivered at the end of the initial test AV delay interval, measuring right ventricular blood pressure and providing a right ventricular pressure (RVP) signal;

    (d) deriving a pressure rate of change signal (dP/dt) from the measured RVP signal;

    (e) determining a peak amplitude of the dP/dt signal;

    (f) measuring the RVP signal amplitude at the determined peak dP/dt signal as an estimated Pulmonary Artery Diastolic (EPAD) pressure;

    (g) repeating steps (c)-(f) while a stable atrial heart rate continues with a set of adjusted test AV delay intervals changed by a predetermined delta value between a minimum and a maximum AV delay interval to derive a set of EPAD pressure values;

    (h) identifying the test AV delay interval providing the lowest amplitude EPAD pressure value; and

    (i) selecting the identified test AV delay interval as the AV delay interval employed in the A-V synchronous pacing method.

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