Method and apparatus for determining atrial lead disclocation and confirming diagnosis of atrial tachyarrhythimias
First Claim
1. A method of determining the location of the atrial pace/sense electrode(s) of an atrial pace lead in a cardiac stimulation system of the type comprising a timing and control sub-system, an atrial pulse generator coupled with the atrial pace lead for providing atrial pace pulses to the atrial pace lead, a ventricular sense amplifier coupled with a ventricular sense lead having ventricular sense electrode(s) positioned in contact with the ventricle for providing a ventricular sense signal to the timing and control sub-system, the method comprising the steps of operating the timing and control sub-system in:
- (a) providing a threshold AV delay interval correlated with the AV conduction time of an atrial depolarization wave originating in the atrium and eliciting a responsive ventricular depolarization wave conducted in the ventricular septum;
(b) operating the atrial pulse generator to generate and apply an atrial pace pulse to the atrial pace electrode(s);
(c) sensing, through operation of the ventricular sense amplifier, the following ventricular depolarization at the ventricular sense electrode(s) as a ventricular sense event;
(d) measuring the time interval between the applied atrial pace pulse and the ventricular sense event as a measured AV delay interval;
(e) comparing the measured AV delay interval to the threshold AV delay interval; and
(f) determining that the atrial pace electrode(s) is in contact with the right atrium if the measured AV delay interval is longer than the threshold AV delay interval.
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Accused Products
Abstract
In a dual chamber cardiac stimulators, e.g. cardiac pacemaker or pacemaker/cardioverter/defibrillator (PCD) system, which relies upon the detection of atrial depolarizations or the stimulation of the atria in the performance of a defined function, a method and apparatus for determining the existence of an atrial pace/sense electrode(s) dislocation from an atrial site to a position inferior to the AV node of the heart thereby affecting a function, e.g. providing a false indication of atrial tachyarrhythmia. The determination of the occurrence of a dislocation of the atrial pace/sense electrode is effected by applying a test pace pulse to the atrial pace/sense electrode; detecting the immediately following ventricular depolarization from a ventricular sense electrode; measuring the interval between the delivered atrial pace pulse and the detected ventricular depolarization; comparing the measured interval to a threshold AV interval; and determining that the atrial pace/sense electrode is in contact with the right atrium if the measured interval is longer than the threshold AV interval. Preferably, the determination is effected by: providing a first signal when the measured AV interval exceeds the threshold AV interval and a second signal when the measured AV interval is less than the threshold AV interval; applying a series of M atrial pace pulses to the atrial pace/sense electrode; counting the number of first and second signals provided in response to the series of atrial pace pulses; and determining that the atrial pace/sense electrode is located in the right atrium when a number of first signals are provided in a series of delivered atrial pace pulses. Confirmation of a provisional tachyarrhythmia is also made from the number of first and second signals.
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Citations
30 Claims
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1. A method of determining the location of the atrial pace/sense electrode(s) of an atrial pace lead in a cardiac stimulation system of the type comprising a timing and control sub-system, an atrial pulse generator coupled with the atrial pace lead for providing atrial pace pulses to the atrial pace lead, a ventricular sense amplifier coupled with a ventricular sense lead having ventricular sense electrode(s) positioned in contact with the ventricle for providing a ventricular sense signal to the timing and control sub-system, the method comprising the steps of operating the timing and control sub-system in:
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(a) providing a threshold AV delay interval correlated with the AV conduction time of an atrial depolarization wave originating in the atrium and eliciting a responsive ventricular depolarization wave conducted in the ventricular septum; (b) operating the atrial pulse generator to generate and apply an atrial pace pulse to the atrial pace electrode(s); (c) sensing, through operation of the ventricular sense amplifier, the following ventricular depolarization at the ventricular sense electrode(s) as a ventricular sense event; (d) measuring the time interval between the applied atrial pace pulse and the ventricular sense event as a measured AV delay interval; (e) comparing the measured AV delay interval to the threshold AV delay interval; and (f) determining that the atrial pace electrode(s) is in contact with the right atrium if the measured AV delay interval is longer than the threshold AV delay interval. - View Dependent Claims (2, 3, 4, 5, 6, 7)
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8. Apparatus for determining the location of the atrial pace electrode(s) of an atrial pacing lead in a cardiac stimulation system of the type comprising a timing and control sub-system, an atrial pulse generator coupled with the atrial pace lead for providing atrial pace pulses to the atrial pace lead, and a ventricular sense amplifier coupled with a ventricular sense lead having ventricular sense electrode(s) positioned in contact with the ventricle for providing a ventricular sense signal to the timing and control sub-system, the apparatus further comprising:
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(a) means for providing a threshold AV delay interval correlated with the AV conduction time of an atrial depolarization wave originating in the atrium and eliciting a responsive ventricular depolarization wave conducted in the ventricular septum; (b) means for operating the atrial pulse generator to generate and apply an atrial pace pulse to the atrial pace electrode(s); (c) means for sensing, through operation of the ventricular sense amplifier, the following ventricular depolarization at the ventricular sense electrode(s) as a ventricular sense event; (d) means for measuring the time interval between the applied atrial pace pulse and the ventricular sense event as a measured AV delay interval; (e) means for comparing the measured AV delay interval to the threshold AV delay interval; and (f) means for determining that the atrial pace electrode(s) is in contact with the right atrium if the measured AV delay interval is longer than the threshold AV delay interval. - View Dependent Claims (9, 10, 11, 12, 13, 14)
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15. A method of confirming a provisional diagnosis of an atrial tachyarrhythmia in a dual chamber, anti-tachyarrhythmia cardiac stimulation system of the type comprising a timing and control sub-system, an atrial sense amplifier and atrial pulse generator coupled with an atrial pace/sense lead, the atrial sense amplifier providing atrial sense signals to the timing and control sub-system and the atrial pulse generator providing atrial pace pulses to the atrial pace/sense lead, a ventricular sense amplifier coupled with a ventricular sense lead having ventricular sense electrode(s) positioned in contact with the ventricle for providing a ventricular sense signal to the timing and control sub-system, the method comprising the steps of operating the timing and control sub-system in:
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(a) provisionally diagnosing the existence of an atrial tachyarrhythmia from the atrial sense signals; (b) providing a threshold AV delay interval correlated with the AV conduction time of an atrial depolarization wave originating in the atrium and eliciting a responsive ventricular depolarization wave conducted in the ventricular septum; (c) operating the atrial pulse generator to generate and apply an atrial pace pulse to the atrial pace/sense electrode(s); (d) sensing, through operation of the ventricular sense amplifier, the following ventricular depolarization at the ventricular sense electrode(s) as a ventricular sense event; (e) measuring the time interval between the applied atrial pace pulse and the ventricular sense event as a measured AV delay interval; (f) comparing the measured AV delay interval to the threshold AV delay interval; (g) confirming the provisional diagnosis when the measured AV delay interval is longer than the threshold AV delay interval signifying that the atrial pace/sense electrode(s) are located within the right atrium. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22)
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23. Apparatus for confirming a provisional diagnosis of an atrial tachyarrhythmia in a dual chamber, anti-tachyarrhythmia cardiac stimulation system of the type comprising a timing and control sub-system, an atrial sense amplifier and atrial pulse generator coupled with an atrial pace/sense lead, the atrial sense amplifier providing atrial sense signals to the timing and control sub-system and the atrial pulse generator providing atrial pace pulses to the atrial pace/sense lead, a ventricular sense amplifier coupled with a ventricular sense lead having ventricular sense electrode(s) positioned in contact with the ventricle for providing a ventricular sense signal to the timing and control sub-system, the apparatus further comprising:
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(a) means for provisionally diagnosing the existence of an atrial tachyarrhythmia from the atrial sense signals; (b) means for providing a threshold AV delay interval correlated with the AV conduction time of an atrial depolarization wave originating in the atrium and eliciting a responsive ventricular depolarization wave conducted in the ventricular septum; (c) means for operating the atrial pulse generator to generate and apply an atrial pace pulse to the atrial pace/sense electrode(s); (d) means for sensing, through operation of the ventricular sense amplifier, the following ventricular depolarization at the ventricular sense electrode(s) as a ventricular sense event; (e) means for measuring the time interval between the applied atrial pace pulse and the ventricular sense event as a measured AV delay interval; (f) means for comparing the measured AV delay interval to the threshold AV delay interval; (g) means for confirming the provisional diagnosis of atrial tachyarrhythmia if the measured AV delay interval is longer than the threshold AV delay interval. - View Dependent Claims (24, 25, 26, 27, 28, 29, 30)
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Specification