Process of controlling a dual chamber cardiac pacemaker
First Claim
1. A process of controlling a dual chamber cardiac pacemaker operable to sense atrial and ventricular depolarizations, to stimulate an atrium and a ventricle, and to determine an atrial rhythm based on an interval between successive sensed atrial depolarizations and having a fallback mode of de-synchronization of a ventricular stimulation when the atrial rhythm exceeds an allowable level, and a mode of progressive re-synchronization in case of a return of the atrial rhythm to the allowable level comprising:
- (a) sensing an atrial depolarization, defining a window of Detection of the Acceleration of the Atrial Rhythm (DAAR) in response to a sensed atrial depolarization, said DAAR having a duration that is a function of a preceding determined atrial rhythm, and further comprising at least one of the preceding intervals between successive sensed atrial depolarizations;
(b) sensing a next atrial depolarization, and in response thereto, starting a delay of an Atrial Escape Interval (AEI); and
(c) determining if said next sensed atrial depolarization has occurred in the defined DAAR window duration, and commanding if necessary a following atrial stimulation according to the started AEI delay,wherein the method step (a) further comprises adapting the duration of the DAAR window as a function of the preceding atrial rhythm and selecting a first DAAR window duration for a rapid atrial rhythm and a second DAAR window duration for a slow atrial rhythm, and discriminating between atrial extrasystoles (AES) and a physiological acceleration of the atrial rhythm based on said selected DAAR window duration.
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Abstract
A process for controlling a dual chamber cardiac pacemaker having a fallback mode of de-synchronization of the ventricular stimulation when the atrial rhythm exceeds an allowable level, and a mode of progressive re-synchronization in case of the return of the atrial rhythm to the allowable level. In the process:
(a) at each detection of an atrial depolarization, one defines a window of Detection of the Acceleration of the Atrial Rhythm (DAAR) whose duration is a function the preceding atrial rhythm, evaluated according to the duration of one or an average of several of preceding atrial intervals,
(b) at the detection of the next atrial depolarization, one starts an Atrial Escape Interval (AEI), and
(c) if this next atrial depolarization has occurred in the DAAR window, one commands if necessary a consecutive
atrial stimulation according to the AEI thus defined. According to the present invention, in step (a), one adapts the duration of the DAAR window as a function of the preceding atrial rhythm in a manner to define a first window for a determined rapid atrial rhythm and a second window for a determined slow atrial rhythm, which allows a discrimination between atrial extrasystoles (AES) and physiological accelerations of the atrial rhythm.
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Citations
34 Claims
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1. A process of controlling a dual chamber cardiac pacemaker operable to sense atrial and ventricular depolarizations, to stimulate an atrium and a ventricle, and to determine an atrial rhythm based on an interval between successive sensed atrial depolarizations and having a fallback mode of de-synchronization of a ventricular stimulation when the atrial rhythm exceeds an allowable level, and a mode of progressive re-synchronization in case of a return of the atrial rhythm to the allowable level comprising:
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(a) sensing an atrial depolarization, defining a window of Detection of the Acceleration of the Atrial Rhythm (DAAR) in response to a sensed atrial depolarization, said DAAR having a duration that is a function of a preceding determined atrial rhythm, and further comprising at least one of the preceding intervals between successive sensed atrial depolarizations; (b) sensing a next atrial depolarization, and in response thereto, starting a delay of an Atrial Escape Interval (AEI); and (c) determining if said next sensed atrial depolarization has occurred in the defined DAAR window duration, and commanding if necessary a following atrial stimulation according to the started AEI delay, wherein the method step (a) further comprises adapting the duration of the DAAR window as a function of the preceding atrial rhythm and selecting a first DAAR window duration for a rapid atrial rhythm and a second DAAR window duration for a slow atrial rhythm, and discriminating between atrial extrasystoles (AES) and a physiological acceleration of the atrial rhythm based on said selected DAAR window duration. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15)
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16. A method for controlling a dual chamber pacemaker having atrial and ventricular depolarization monitoring circuits and atrial and ventricular stimulating circuits and a fallback operating mode in which the stimulation of the ventricles is desynchronized from an atrial rhythm comprising:
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a. monitoring the spontaneous and stimulated atrial depolarization events as p waves; b. monitoring stimulated and spontaneous ventricular depolarization events; c. determining a ventricular rhythm from the monitored ventricular depolarization events; d. detecting a first spontaneous P wave; e. determining an atrial rhythm as a function of a pair of consecutive P waves; f. selecting, in response to said detected first spontaneous P wave, a duration as a window of Detection of Acceleration of the Atrial Rhythm (DAAR), said selected duration being one of a first duration corresponding to said determined atrial rhythm preceding said detected first spontaneous P wave representing a fast atrial rhythm and a second duration corresponding to said determined atrial rhythm preceding said detected first spontaneous P wave representing a slow atrial rhythm; g. initiating, in response to the detection of said first spontaneous P wave, the selected DAAR window; h. detecting a next spontaneous P wave subsequent to said detected first spontaneous P wave; i. initiating an atrial escape interval (AEI) in response to said detected next spontaneous P wave, j. determining whether or not the detected next spontaneous P wave is detected during the initiated selected DAAR window; and k. in response to said detected next spontaneous P wave being detected during said DAAR window, stimulating if necessary the ventricle at the end of the AEI. - View Dependent Claims (17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34)
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Specification