Multiple channel, sequential, cardiac pacing systems

• US 6,070,101 A
• Filed: 04/22/1999
• Issued: 05/30/2000
• Est. Priority Date: 04/28/1998
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Nijsten, Albert-Jan, De Roos, Cobus, Struble, Chester L.
• Primary Examiner(s): Kamm, William E.
• Application Number:
  US09/296,905
• Time in Patent Office: 404 Days
• Field of Search: 607/9, 607/14, 607/30
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence

Abstract

Multi-chamber cardiac pacing systems for providing synchronous pacing to at least the two upper heart chambers or the two lower heart chambers or to three heart chambers or to all four heart chambers employing programmable conduction delay window (CDW) times timed out from paced and sensed events occurring in each heart chamber are disclosed. The synchronous pacing of one of the right and left heart chambers is provided on demand following expiration of programmable pace and sense CDWs that are started by both a paced event and a sensed event first occurring in the other of the right and left heart chambers. The delivery of the pacing pulse is inhibited by a sensed event detected in the other of the right and left heart chambers before the expiration of the corresponding CDW. In a four channel atrial and ventricular pacing system, the right and left atrial chambers are sensed and paced as necessary upon at the end of a V-A escape interval and right and left AV delays are commenced for sensing ventricular depolarizations in the right and left ventricles. The four channel system is programmable to pace and sense in three selected heart chambers.

Claims

1. A pacing system for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in one of the right or left atrium to the other of the left or right atrium comprising:

right atrial lead means for locating first and second right atrial pace/sense electrodes in relation with the right atrium;

left atrial lead means for locating first and second left atrial pace/sense electrodes in relation with the left atrium;

right atrial depolarization sensing means coupled with said right atrial lead means for sensing spontaneous cardiac depolarizations originating in the right atrium and conducted cardiac depolarizations originating in the left atrial from a spontaneous cardiac depolarization or delivery of a left atrial pacing pulse to the left atrium and for providing a right atrial sensed event signal in response to either a sensed spontaneous or conducted cardiac depolarization;

left atrial depolarization sensing means coupled with said left atrial lead means for sensing spontaneous cardiac depolarizations originating in the left atrium and conducted cardiac depolarizations originating in the right atrial from a spontaneous cardiac depolarization or delivery of a right atrial pacing pulse to the right atrium and for providing a left atrial sensed event signal in response to either a sensed spontaneous or conducted cardiac depolarization;

escape interval timing means for timing an escape interval establishing a pacing rate and providing an escape interval pace trigger signal at the time out of the escape interval, the escape interval timing means further comprising reset means for restarting the timing of the escape interval in response to one of the right or left atrial sensed event signals;

right atrial pacing pulse output means coupled with said right atrial lead means and selectively responsive to an applied pace trigger signal for generating and delivering a right atrial pacing pulse to said right atrial lead means to evoke a right atrial depolarization;

left atrial pacing pulse output means coupled with said left atrial lead means and selectively responsive to an applied pace trigger signal for generating and delivering a left atrial pacing pulse to said left atrial lead means to evoke a left atrial depolarization;

means for applying said escape interval pace trigger signal to one of said right atrial pacing pulse output means or said left atrial pacing pulse output means;

left atrial conduction delay window timing means coupled with said escape interval timing means and said right atrial depolarization sensing means for timing a left atrial conduction delay window from a right atrial sensed event signal and selectively from an escape interval pace trigger signal and for providing a left atrial pace trigger signal at the expiration of the left atrial conduction delay window time, said left atrial conduction delay window timing means further coupled with said left atrial depolarization sensing means and comprising left atrial window terminating means for terminating the timing out of the left atrial conduction delay window in response to a left atrial sensed event signal;

means for applying said left atrial pace trigger signal to said left atrial pacing pulse output means as a pace trigger signal for triggering the generation and delivery of a left atrial pacing pulse to said left atrial lead means;

right atrial conduction delay window timing means coupled with said escape interval timing means and said left atrial depolarization sensing means for timing a right atrial conduction delay window from a left atrial sensed event signal and selectively from an escape interval pace trigger signal and for providing a right atrial pace trigger signal at the expiration of the right atrial conduction delay window time, said right atrial conduction delay window timing means further coupled with said right atrial depolarization sensing means and comprising right atrial window terminating means for terminating the timing out of the right atrial conduction delay window in response to a right atrial sensed event signal; and

means for applying said right atrial pace trigger signal to said right atrial pacing pulse output means as a pace trigger signal for triggering the generation and delivery of a right atrial pacing pulse to said right atrial lead means;

whereby an excessive conduction delay between a spontaneous or evoked depolarization in the right atrium and the conducted depolarization wave in the left atrial or an excessive conduction delay between a spontaneous or evoked depolarization in the left atrium and the conducted depolarization wave in the right atrium is corrected by generation and delivery of a pacing pulse to the left or right atrium, respectively at the timing out of the corresponding conduction delay window.

2. The pacing system of claim 1, further comprising means for programming said left atrial conduction delay window in a range of 0-100 msec.

3. The pacing system of claim 1, further comprising means for programming said right atrial conduction delay window in a range of 0-100 msec.

4. The pacing system of claim 1, further comprising:

means for preventing the sensing of spontaneous and evoked cardiac depolarizations in the right atrium and the provision of a right atrial sensed event signal in response thereto for the duration of a right atrial blanking period in response to the generation of an atrial pacing pulse; and

means for preventing the sensing of spontaneous and evoked cardiac depolarizations in the left atrium and the provision of a left atrial sensed event signal in response thereto for the duration of a left atrial blanking period in response to the generation of an atrial pacing pulse.

5. The pacing system of claim 4, further comprising means for programming said left atrial conduction delay window in a range of 0-100 msec.

6. The pacing system of claim 4, further comprising means for programming said right atrial conduction delay window in a range of 0-100 msec.

7. A pacing method for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in one of the right or left atrium to the other of the left or right atrium comprising the steps of:

locating first and second right atrial pace/sense electrode in relation with the right atrium;

locating first and second left atrial pace/sense electrodes in relation with the left atrium;

sensing spontaneous and evoked cardiac depolarizations in the right atrium across said right atrial pace/sense electrodes and providing a right atrial sensed event signal;

sensing spontaneous and evoked cardiac depolarizations in the left atrium across said left atrial pace/sense electrodes and providing a left atrial sensed event signal;

timing an escape interval establishing a pacing rate and providing an escape interval pace trigger signal at the time out of the escape interval;

restarting the timing of the escape interval in response to one of the right or left atrial sensed event signals;

in response to the escape interval pace trigger signal, selectively triggering either right atrial pacing pulse output means coupled with said right atrial pace/sense electrodes to generate and deliver a right atrial pacing pulse to said right atrial pace/sense electrodes to evoke a right atrial depolarization or left atrial pacing pulse output means coupled with said left atrial pace/sense electrodes to generate and deliver a left atrial pacing pulse to said left atrial lead means to evoke a left atrial depolarization;

timing a left atrial conduction delay window from a right atrial sensed event signal or from generation of a right atrial pacing pulse and providing a left atrial pace trigger signal at the expiration of the left atrial conduction delay window

terminating the timing out of the left atrial conduction delay window in response to a left atrial sensed event signal;

applying said left atrial pace trigger signal to said left atrial pacing pulse output means to trigger the generation and delivery of a left atrial pacing pulse to said left atrial lead means;

timing a right atrial conduction delay window from a left atrial sensed event signal or from generation of a left atrial pacing pulse and providing a right atrial pace trigger signal at the expiration of the right atrial conduction delay window

terminating the timing out of the right atrial conduction delay window in response to a right atrial sensed event signal; and

applying said right atrial pace trigger signal to said right atrial pacing pulse output means to trigger the generation and delivery of a right atrial pacing pulse to said right atrial lead means;

whereby an excessive conduction delay between a spontaneous or evoked depolarization in one of the right or left atrium and the conducted depolarization wave in the other of the left or right atrium is corrected by generation and delivery of a pacing pulse at the timing out of the conduction delay window.

8. The pacing method of claim 7, further comprising the steps of:

programming said left atrial conduction delay window in a range of 0-100 msec; and

programming said right atrial conduction delay window in a range of 0-100 msec.

9. The pacing method of claim 7, further comprising the steps of:

preventing the sensing of spontaneous and evoked cardiac depolarizations in the right atrium and the provision of a right atrial sensed event signal in response thereto for the duration of a right atrial blanking period in response to the generation of an atrial pacing pulse; and

preventing the sensing of spontaneous and evoked cardiac depolarizations in the left atrium and the provision of a left atrial sensed event signal in response thereto for the duration of a left atrial blanking period in response to the generation of an atrial pacing pulse.

10. The pacing method of claim 9, further comprising the steps of:

programming said left atrial conduction delay window in a range of 0-100 msec; and

programming said right atrial conduction delay window in a range of 0-100 msec.

11. A pacing method for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in the right atrium to the left atrium comprising the steps of:

locating first and second right atrial pace/sense electrode in relation with the right atrium;

locating first and second left atrial pace/sense electrodes in relation with the left atrium;

sensing spontaneous and evoked cardiac depolarizations in the right atrium across said right atrial pace/sense electrodes and providing a right atrial sensed event signal;

sensing spontaneous and evoked cardiac depolarizations in the left atrium across said left atrial pace/sense electrodes and providing a left atrial sensed event signal;

timing an escape interval establishing a pacing rate and providing an escape interval pace trigger signal at the time out of the escape interval;

restarting the timing of the escape interval in response to the right atrial sensed event signals;

in response to the escape interval pace trigger signal, triggering the right atrial pacing pulse output means coupled with said right atrial pace/sense electrodes to generate and deliver a right atrial pacing pulse to said right atrial pace/sense electrodes to evoke a right atrial depolarization;

timing a left atrial conduction delay window from a right atrial sensed event signal or from generation of a right atrial pacing pulse and providing a left atrial pace trigger signal at the expiration of the left atrial conduction delay window

terminating the timing out of the left atrial conduction delay window in response to a left atrial sensed event signal; and

applying said left atrial pace trigger signal to said left atrial pacing pulse output means to trigger the generation and delivery of a left atrial pacing pulse to said left atrial lead means;

whereby an excessive conduction delay between a spontaneous or evoked depolarization in the right atrium and the conducted depolarization wave in the left atrium is corrected by generation and delivery of a pacing pulse at the timing out of the conduction delay window.

12. The pacing method of claim 11, further comprising the step of:

programming said left atrial conduction delay window in a range of 0-100 msec.

13. The pacing method of claim 11, further comprising the steps of:

preventing the sensing of spontaneous and evoked cardiac depolarizations in the right atrium and the provision of a right atrial sensed event signal in response thereto for the duration of a right atrial blanking period in response to the generation of an atrial pacing pulse; and

preventing the sensing of spontaneous and evoked cardiac depolarizations in the left atrium and the provision of a left atrial sensed event signal in response thereto for the duration of a left atrial blanking period in response to the generation of an atrial pacing pulse.

14. The pacing method of claim 13, further comprising the step of:

programming said left atrial conduction delay window in a range of 0-100 msec.

15. A pacing system for improving the hemodynamic efficiency of a sick heart suffering from conduction delays in conducting spontaneous or evoked depolarizations originating in the right atrium to the left atrium comprising:

right atrial lead means for locating first and second right atrial pace/sense electrode in relation with the right atrium;

left atrial lead means for locating first and second left atrial pace/sense electrodes in relation with the left atrium;

right heart sensing means for sensing spontaneous and evoked cardiac depolarizations in the right atrium across said right atrial pace/sense electrodes and providing a right atrial sensed event signal;

left heart sensing means for sensing spontaneous and evoked cardiac depolarizations in the left atrium across said left atrial pace/sense electrodes and providing a left atrial sensed event signal;

escape interval timing means for timing an escape interval establishing a pacing rate and providing an escape interval pace trigger signal at the time out of the escape interval;

reset means for restarting the timing of the escape interval in response to the right atrial sensed event signals;

right atrial pacing pulse output means coupled with said right atrial pace/sense electrodes responsive to the escape interval pace trigger signal for generating and delivering a right atrial pacing pulse to said right atrial pace/sense electrodes to evoke a right atrial depolarization;

means for timing a left atrial conduction delay window from a right atrial sensed event signal or from generation of a right atrial pacing pulse and providing a left atrial pace trigger signal at the expiration of the left atrial conduction delay window;

means for terminating the timing out of the left atrial conduction delay window in response to a left atrial sensed event signal; and

left atrial pacing pulse output means coupled with said left atrial pace/sense electrodes and responsive to said left atrial pace trigger signal for generating and delivering a left atrial pacing pulse to said left atrial lead means;

whereby an excessive conduction delay between a spontaneous or evoked depolarization in the right atrium and the conducted depolarization wave in the left atrium is corrected by generation and delivery of a pacing pulse at the timing out of the conduction delay window.

16. The pacing system of claim 15, further comprising means for programming said left atrial conduction delay window in a range of 0-100 msec.

17. The pacing system of claim 16, further comprising:

means for preventing the sensing of spontaneous and evoked cardiac depolarizations in the right atrium and the provision of a right atrial sensed event signal in response thereto for the duration of a right atrial blanking period in response to the generation of an atrial pacing pulse; and

means for preventing the sensing of spontaneous and evoked cardiac depolarizations in the left atrium and the provision of a left atrial sensed event signal in response thereto for the duration of a left atrial blanking period in response to the generation of an atrial pacing pulse.

18. The pacing system of claim 17, further comprising means for programming said left atrial conduction delay window in a range of 0-100 msec.