Cardiac pacing using adjustable atrio-ventricular delays
First Claim
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1. A method, comprising:
- selecting a cardiac reference event which repeats every cardiac cycle;
selecting a cardiac variable event which changes as a function of a cardiac performance parameter, the cardiac performance parameter related to optimal atrio-ventricular delay;
measuring an intrinsic time interval between the cardiac reference event and the cardiac variable event in an unpaced condition;
ascertaining an optimal atrio-ventricular delay for optimizing the cardiac performance parameter;
collecting intrinsic time intervals and optimal atrio-ventricular delays for a number of patients;
producing a mathematical relationship for the intrinsic time intervals and the optimal atrio-ventricular delays.
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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.
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Citations
28 Claims
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1. A method, comprising:
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selecting a cardiac reference event which repeats every cardiac cycle;
selecting a cardiac variable event which changes as a function of a cardiac performance parameter, the cardiac performance parameter related to optimal atrio-ventricular delay;
measuring an intrinsic time interval between the cardiac reference event and the cardiac variable event in an unpaced condition;
ascertaining an optimal atrio-ventricular delay for optimizing the cardiac performance parameter;
collecting intrinsic time intervals and optimal atrio-ventricular delays for a number of patients;
producing a mathematical relationship for the intrinsic time intervals and the optimal atrio-ventricular delays. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14)
ascertaining a second optimal atrio-ventricular delay for optimizing a second cardiac performance parameter;
collecting intrinsic time intervals and second optimal atrio-ventricular delays for a number of patients;
producing a second mathematical relationship for the intrinsic time intervals, the optimal atrio-ventricular delays and the second optimal atrio-ventricular delays.
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10. The method of claim 9, wherein the second mathematical relationship results in an optimal atrio-ventricular delay for optimizing the cardiac performance parameter and the second cardiac performance parameter.
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11. The method of claim 9, wherein the cardiac performance parameter is contractility and the second cardiac performance parameter is stroke volume.
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12. The method of claim 11, wherein the mathematical relationship among a variable (AVDcs) representing an atrio-ventricular delay for both contractility and stroke volume, a variable (PRm) representing a time interval measured from a right atrial sensing marker (P) to a right ventricular sensing marker (Rm), and constants (K3 and K4) is:
AVDcs=K3 PRm−
K4 milliseconds.
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13. The method of claim 12, wherein the mathematical relationship is:
AVDcs=0.5 PRm−
15 milliseconds.
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14. The method of claim 9, wherein the atrio-ventricular delay is switchable for a number of different optimal cardiac performance parameters and combinations of cardiac performance parameters.
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15. A method, comprising:
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selecting a cardiac reference event which repeats every cardiac cycle;
selecting a cardiac variable event which changes as a function of a cardiac performance parameter, the cardiac performance parameter related to optimal atrio-ventricular delay;
measuring an intrinsic time interval between the cardiac reference event and the cardiac variable event in an unpaced condition;
ascertaining an optimal atrio-ventricular delay for optimizing the cardiac performance parameter, including;
applying a pacing signal with varying atrio-ventricular delays while monitoring the cardiac performance parameter; and
determining an optimal atrio-ventricular delay for optimizing the cardiac performance parameter;
collecting intrinsic time intervals and optimal atrio-ventricular delays for a number of patients; and
producing a mathematical relationship for the intrinsic time intervals and the optimal atrio-ventricular delay pairs. - View Dependent Claims (16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28)
ascertaining a second optimal atrio-ventricular delay for optimizing a second cardiac performance parameter;
collecting intrinsic time intervals and second optimal atrio-ventricular delays for a number of patients;
producing a second mathematical relationship for the intrinsic time intervals, the optimal atrio-ventricular delays and the second optimal atrio-ventricular delays.
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24. The method of claim 23, wherein the second mathematical relationship results in an optimal atrio-ventricular delay for optimizing the cardiac performance parameter and the second cardiac performance parameter.
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25. The method of claim 23, wherein the cardiac performance parameter is contractility and the second cardiac performance parameter is stroke volume.
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26. The method of claim 25, wherein the mathematical relationship among a variable (AVDcs) representing an atrio-ventricular delay for both contractility and stroke volume, a variable (PRm) representing a time interval measured from a right atrial sensing marker (P) to a right ventricular sensing marker (Rm), and constants (K3 and K4) is:
AVDcs=K3 PRm−
K4 milliseconds.
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27. The method of claim 26, wherein the mathematical relationship is:
AVDcs=0.5 PRm−
15 milliseconds.
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28. The method of claim 23, wherein the atrio-ventricular delay is switchable for a number of different optimal cardiac performance parameters and combinations of cardiac performance parameters.
Specification