System and method of identifying fusion for dual-chamber automatic capture stimulation device
First Claim
1. A method of detecting a fusion event following a delivery of a ventricular stimulation pulse, comprising:
- detecting a far-field R-wave on an atrial channel, within a predefined time interval after verification of loss of capture on a ventricular channel;
confirming the fusion event if the far-field R-wave is detected on the atrial channel following the ventricular stimulation pulse; and
confirming loss of capture if no far-field R-wave is detected on the atrial channel.
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Abstract
A multi-chamber stimulation device and associated method reliably and automatically distinguish fusion from loss of capture during ventricular stimulation. The stimulation device provides immediate and accurate fusion detection when a loss of capture is suspected in the ventricles without delivering back-up stimulation pulses. To achieve this objective, the far-field signal present in the atrial channel is examined for evidence of a far-field R-wave whenever the ventricular channel detects a loss of capture. If a far-field R-wave is present, fusion is confirmed, and a far-field R-wave is absent, loss of capture is confirmed. Additionally, the stimulation device inhibits unnecessary back-up stimulation and threshold tests when fusion occurs, and provides appropriate adjustment of stimulation parameters based on confirmed fusion detection such that fusion re-occurrence is minimized.
168 Citations
23 Claims
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1. A method of detecting a fusion event following a delivery of a ventricular stimulation pulse, comprising:
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detecting a far-field R-wave on an atrial channel, within a predefined time interval after verification of loss of capture on a ventricular channel;
confirming the fusion event if the far-field R-wave is detected on the atrial channel following the ventricular stimulation pulse; and
confirming loss of capture if no far-field R-wave is detected on the atrial channel. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12)
verifying capture if the detected evoked response matches the morphology template.
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10. The method according to claim 9, wherein detecting the far-field R-wave on the atrial channel from a sampled atrial intra-cardiac electrogram signal if any one condition occurs:
- the detected evoked response does not match the morphology template.
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11. The method according to claim 10, wherein confirming the occurrence of the fusion event if a far-field signal on the atrial channel substantially coincides in time with a suspected fusion event on the ventricular channel.
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12. The method according to claim 11, further including incrementing an AV interval and a PV interval subsequent to confirmation of the fusion event.
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13. A stimulation device for detecting a fusion event, comprising:
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a pulse generator configured to deliver a ventricular stimulation pulse;
an atrial sensing circuitry responsive to the ventricular stimulation pulse, to detect a far-field R-wave on an atrial channel, within a predefined time interval after verification of loss of capture on a ventricular channel;
a controller connected to the atrial sensing circuitry and adapted to confirm the fusion event if the far-field R-wave is detected on the atrial channel following the ventricular stimulation pulse, and confirm loss of capture if no far-field R-wave is detected on the atrial channel. - View Dependent Claims (14, 15, 16, 17, 18, 19, 20, 21, 22)
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23. A method of inhibiting a back-up stimulation pulse following the delivery of a ventricular stimulation pulse, comprising:
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detecting a far-field R-wave on an atrial channel, within a predefined time interval after verification of loss of capture on a ventricular channel;
inhibiting delivery of the back-up stimulation pulse if the far-field R-wave is detected on the atrial channel following the ventricular stimulation pulse; and
delivery a back-up stimulation pulse if no far-field R-wave is detected on the atrial channel.
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Specification