Cardiac pacing using adjustable atrio-ventricular delays
First Claim
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1. A method, comprising:
- measuring an interval during a nonpaced systolic cycle between a first event and a second event, the first event related to an atrial contraction which is in a first predictable time-dependent relationship and the second event which is in a second predictable time-dependent relationship to a ventricular pacing signal optimally timed for maximum peak positive LV pressure change during systole, (LV+dp/dt);
generating an atrio-ventricular delay (AVDc) calculated from a predetermined mapping of a relationship of the interval to an optimal atrio-ventricular delay for maximum peak positive LV pressure change during systole, (LV+dp/dt); and
delivering a pacing pulse to a ventricle with the generated atrio-ventricular delay (AVDc);
wherein AVDc provides an approximation of the optimal atrio-ventricular delay for pacing the ventricle to provide maximum peak positive LV pressure change during systole, (LVA+dp/dt).
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Abstract
A pacing system for providing optimal hemodynamic cardiac function for parameters such as contractility (peak left ventricle pressure change during systole or LV+dp/dt), or stroke volume (aortic pulse pressure) using system for calculating atrio-ventricular delays for optimal timing of a ventricular pacing pulse. The system providing an option for near optimal pacing of multiple hemodynamic parameters. The system deriving the proper timing using electrical or mechanical events having a predictable relationship with an optimal ventricular pacing timing signal.
269 Citations
54 Claims
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1. A method, comprising:
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measuring an interval during a nonpaced systolic cycle between a first event and a second event, the first event related to an atrial contraction which is in a first predictable time-dependent relationship and the second event which is in a second predictable time-dependent relationship to a ventricular pacing signal optimally timed for maximum peak positive LV pressure change during systole, (LV+dp/dt); generating an atrio-ventricular delay (AVDc) calculated from a predetermined mapping of a relationship of the interval to an optimal atrio-ventricular delay for maximum peak positive LV pressure change during systole, (LV+dp/dt); and delivering a pacing pulse to a ventricle with the generated atrio-ventricular delay (AVDc); wherein AVDc provides an approximation of the optimal atrio-ventricular delay for pacing the ventricle to provide maximum peak positive LV pressure change during systole, (LVA+dp/dt). - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27)
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28. An apparatus, comprising:
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a programmable pulse generator transmitting ventricular pacing pulses with an atrio-ventricular delay (AVDc) calculated from an interval measured during a nonpaced systolic cycle by the programmable pulse generator between a first event and a second event, the first event related to an atrial contraction which is in a first predictable time-dependent relationship and the second event which is in a second predictable time-dependent relationship to a ventricular pacing signal optimally timed for maximum peak positive LV pressure change during systole, (LV+dp/dt) wherein the AVDc is calculated by the programmable pulse generator from a predetermined mapping of a relationship of the interval to an optimal atrio-ventricular delay for maximum peak positive LV pressure change during systole, (LV+dp/dt) and wherein AVDc provides an approximation of the optimal atrio-ventricular delay for pacing the ventricle to provide maximum LV+dp/dt. - View Dependent Claims (29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54)
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Specification