System providing ventricular pacing and biventricular coordination
First Claim
1. A method, comprising:
- obtaining actual timing intervals between cardiac events;
computing a first indicated timing interval based at least on a most recent actual timing interval duration and a previous value of the first indicated timing interval, including weighting at least one of (1) the most recent actual timing interval duration, or (2) the previous value of the first indicated timing interval, based on whether the most-recent actual timing interval is concluded by a paced beat or a sensed beat; and
providing pacing therapy, based on the first indicated timing interval.
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Accused Products
Abstract
A cardiac rhythm management system includes techniques for computing an indicated pacing interval, AV delay, or other timing interval. In one embodiment, a variable indicated pacing interval is computed based at least in part on an underlying intrinsic heart rate. The indicated pacing interval is used to time the delivery of biventricular coordination therapy even when ventricular heart rates are irregular, such as in the presence of atrial fibrillation. In another embodiment, a variable filter indicated AV interval is computed based at least in part on an underlying intrinsic AV interval. The indicated AV interval is used to time the delivery of atrial tracking biventricular coordination therapy when atrial heart rhythms are not arrhythmic. Other indicated timing intervals may be similarly determined. The indicated pacing interval, AV delay, or other timing interval can also be used in combination with a sensor indicated rate indicator.
593 Citations
71 Claims
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1. A method, comprising:
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obtaining actual timing intervals between cardiac events;
computing a first indicated timing interval based at least on a most recent actual timing interval duration and a previous value of the first indicated timing interval, including weighting at least one of (1) the most recent actual timing interval duration, or (2) the previous value of the first indicated timing interval, based on whether the most-recent actual timing interval is concluded by a paced beat or a sensed beat; and
providing pacing therapy, based on the first indicated timing interval. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11)
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12. A method comprising:
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obtaining actual timing intervals between cardiac events;
computing a first indicated timing interval based at least on a most recent actual timing interval duration and a previous value of the first indicated timing interval; and
providing pacing therapy, based on the first indicated timing interval, in which computing the first indicated timing interval is also based on a remotely user-programmable parameter that corresponds to a desired degree of paced beats vs. sensed beats. - View Dependent Claims (13, 14, 15, 16, 17, 18, 19, 20, 21)
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22. A method comprising:
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obtaining actual timing intervals between cardiac events;
computing a first indicated timing interval based at least on a most recent actual timing interval duration and a previous value of the first indicated timing interval; and
providing pacing therapy, based on the first indicated timing interval, in which computing the first indicated timing interval is also based on a goal proportion of paced beats to sensed beats. - View Dependent Claims (23, 24, 25, 26, 27, 28, 29, 30, 31)
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32. A method, comprising:
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obtaining V-V intervals between ventricular beats;
computing a first indicated pacing interval based at least on a most recent V-V interval duration and a previous value of the first indicated pacing interval; and
providing pacing therapy to first and second ventricles, based on the first indicated pacing interval. - View Dependent Claims (33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48)
obtaining an initiating ventricular beat, in one of the first and second ventricles, the initiating ventricular beat initiating a V-V interval; and
obtaining a concluding ventricular beat, in one of the first and second ventricles, the concluding ventricular beat being the next ventricular beat detected after expiration of a first time delay, and the concluding ventricular beat concluding the V-V interval.
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36. The method of claim 32, in which computing the first indicated pacing interval includes differently weighting at least one of (1) the most recent V-V interval duration, or (2) the previous value of the first indicated pacing interval, if the most-recent V-V interval is concluded by a paced beat than if the most recent V-V interval is concluded by a sensed beat.
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37. The method of claim 32, in which computing the first indicated pacing interval includes summing a first addend based on the most recent V-V interval duration and a second addend based on the previous value of the first indicated pacing interval, wherein at least one of the first and second addends is different if the most recent V-V interval is concluded by an intrinsic beat than if the most recent V-V interval is concluded by a paced beat.
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38. The method of claim 32, in which computing the first indicated pacing interval (Tn) is carried out according to Tn=A·
- VVn+B·
Tn−
1, where A and B are coefficients, VVn is the most recent V-V interval duration, and Tn−
1 is the previous value of the first indicated pacing interval.
- VVn+B·
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39. The method of claim 38, in which computing the first indicated pacing interval (Tn) is carried out according to:
- Tn=A·
VVn+B·
Tn−
1, if VVn is concluded by an intrinsic beat, otherwise is carried out according to Tn=C·
VVn+D·
Tn−
1, if VVn is concluded by a paced beat, where C and D are coefficients.
- Tn=A·
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40. The method of claim 39, in which at least one of A, B, C, and D is a function of heart rate.
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41. The method of claim 32, in which computing the first indicated pacing interval (Tn) is carried out according to Tn=a·
- w·
VVn+(1−
w)·
Tn−
1if VVn is concluded by an intrinsic beat, otherwise is carried out according to Tn=b·
w·
VVn+(1−
w)·
Tn−
1, if VVn is concluded by a paced beat, where a, b, and w are coefficients, VVn is the most recent V-V interval duration, and Tn−
1 is the previous value of the first indicated pacing interval.
- w·
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42. The method of claim 32, in which providing pacing therapy is also based on a second indicated pacing interval that is based on a sensor.
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43. The method of claim 32, in which providing pacing therapy is based on the first indicated pacing interval, if an atrial tachyarrhythmia is present, and providing pacing therapy is independent of the first indicated pacing interval if no atrial tachyarrhythmia is present.
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44. The method of claim 43, in which the atrial tachyarrhythmia is atrial fibrillation.
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45. The method of claim 32, in which providing pacing therapy is based on the first indicated pacing interval if the first indicated pacing interval is longer than a first predetermined value, and providing pacing therapy is independent of the first indicated pacing interval if the first indicated pacing interval is shorter than the first predetermined value.
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46. The method of claim 32, in which computing the first indicated pacing interval is also based on a remotely user-programmable parameter that corresponds to a desired degree of paced ventricular beats vs. sensed ventricular beats.
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47. The method of claim 32, in which computing the first indicated pacing interval is also based on a goal proportion of paced ventricular beats to sensed ventricular beats.
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48. The method of claim 32, in which the first indicated pacing interval is limited by at least one of a maximum interval value and a minimum interval value.
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49. A cardiac rhythm management system, comprising:
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a sensing circuit for sensing events;
a controller, obtaining timing intervals between events and computing a first indicated timing interval based at least on a most recent actual timing interval duration and a previous value of the first indicated timing interval;
a filter that computes the first indicated timing interval by weighting at least one of (1) the most recent timing interval duration, or (2) the previous value of the first indicated timing interval, based on whether the most recent actual timing interval is concluded by a paced beat or a sensed beat; and
a therapy circuit, providing pacing therapy based on the first indicated timing interval. - View Dependent Claims (50, 51, 52, 53)
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54. A cardiac rhythm management system, comprising:
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a sensing circuit for sensing events;
a controller, obtaining timing intervals between events and computing a first indicated timing interval based at least on a most recent actual timing interval duration and a previous value of the first indicated timing interval, and in which the first indicated timing interval is also based on a first parameter that corresponds to a desired proportion of paced ventricular beats to sensed ventricular beats; and
a therapy circuit, providing pacing therapy based on the first indicated timing interval. - View Dependent Claims (55, 56, 57)
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58. A cardiac rhythm management system, comprising:
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a sensing circuit for sensing events;
a controller, obtaining timing intervals between events and computing a first indicated timing interval based at least on a most recent actual timing interval duration and a previous value of the first indicated timing interval, and in which the controller includes a goal proportion of paced ventricular beats to sensed ventricular beats, and the first indicated timing interval is also based on the goal; and
a therapy circuit, providing pacing therapy based on the first indicated timing interval. - View Dependent Claims (59, 60, 61)
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62. A cardiac rhythm management system, comprising:
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at least one ventricular sensing circuit;
a controller, the controller including;
an V-V interval timer, obtaining V-V intervals between successive events in at least one ventricle;
a first register, for storing a first indicated pacing interval; and
a filter, updating the first indicated pacing interval based on a most recent V-V interval provided by the VV interval timer and previous value of the first indicated pacing interval stored the first register; and
a ventricular therapy circuit, providing pacing therapy to first and second ventricles based at least partially on the first indicated pacing interval. - View Dependent Claims (63, 64, 65, 66, 67, 68, 69, 70, 71)
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Specification