Multi-site cardiac pacing system having trigger pace window

• US 6,466,820 B1
• Filed: 11/12/1999
• Issued: 10/15/2002
• Est. Priority Date: 12/29/1998
• Status: Expired due to Term

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Kleckner, Karen J., Yerich, Charles G., Juran, Carleen J.
• Primary Examiner(s): Jastrzab, Jeffrey F.
• Assistant Examiner(s): Oropeza, Frances P.
• Application Number:
  US09/439,078
• Time in Patent Office: 1,068 Days
• Field of Search: 600/509, 600/516, 607/4, 607/9, 607/25, 607/5, 607/14, 607/15, 607/28
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

Multi-site cardiac pacing systems for providing pacing to multiple spaced apart sites of a patient'"'"'s heart, including especially but not limited to sites in right heart chamber (RHC) and left heart chamber (LHC), in triggered pacing modes while avoiding inappropriate delivery of triggered pacing to the RHC and/or LHC on a non-refractory sense event that occurs early in the cardiac cycle.

Claims

1. In a cardiac pacemaker, a method of delivering triggered pacing pulses to a ventricle of a heart comprising the steps of:

locating first and second pace/sense electrodes at first and second spaced apart ventricular sites of said ventricle of the heart;

sensing spontaneous cardiac depolarizations traversing one of the other of the first and second pace/sense electrodes and providing a ventricular sense event signal;

upon provision of the ventricular sense event signal, starting and timing out a ventricular escape interval and a trigger pace window that is shorter than the ventricular escape interval;

in a triggered pacing mode, upon provision of a ventricular sense event during the timing out of the ventricular escape interval following the time-out of the trigger pace window, generating and delivering a ventricular pacing pulse or pacing pulses to a selected one or both of the first and second spaced apart sites of the ventricle through a respective one or both of said first and second pace/sense electrodes; and

disabling the triggered pace mode upon provision of the ventricular sense event during the timing out of the ventricular escape interval and the trigger pace window.

2. The method of claim 1, wherein the triggered pacing mode comprises the steps of:

upon provision of the ventricular sense event during the timing out of the ventricular escape interval, delivering a first ventricular pacing pulse to a predetermined one of the first or the second pace/sense electrodes to pace the ventricle at the site of that pace/sense electrode;

upon provision of the ventricular sense event signal commencing and timing out a triggered pacing delay; and

at the time-out of the triggered pacing delay, delivering a second ventricular pacing pulse to the other of the first or the second pace/sense electrodes to pace the ventricle at the site of that pace/sense electrode,

whereby a synchronized depolarization of the ventricle in a predetermined sequence is effected by the first and second ventricular pacing pulses.

3. The method of claim 1, wherein the triggered pacing mode comprises the steps of:

upon provision of a ventricular sense event during the timing out of the ventricular escape interval, delivering a first ventricular pacing pulse to a predetermined one of the first or the second pace/sense electrodes to pace the ventricle at the site of that pace/sense electrode regardless of whether the ventricular sense event originates from a spontaneous ventricular cardiac depolarization detected at the first or second spaced apart ventricular sites;

upon provision of the ventricular sense event, commencing and timing out a triggered pacing delay; and

at the time-out of the triggered pacing delay, delivering a second pacing pulse to the other of the first or the second pace/sense electrodes to pace the ventricle at the site of that pace/sense electrode,

whereby a synchronized depolarization of the heart in a predetermined sequence is effected by the first and second ventricular pacing pulses.

4. The method of claim 1, wherein the sensing step further comprises the step of:

coupling a single ventricular sense amplifier to the first and second pace/sense electrodes for sensing ventricular depolarizations traversing one or the other of the first and second spaced apart ventricular sites.

5. The method of claim 1, further comprising the step of:

locating an indifferent pace/sense electrode in relation to the heart; and

wherein;

the sensing step further comprises the step of coupling a single ventricular sense amplifier to the first and second pace/sense electrodes to sense depolarizations traversing one or the other of the first and second spaced apart ventricular sites; and

the step of delivering a ventricular pacing pulse in the triggered pacing mode comprises delivering a first ventricular pacing pulse between a predetermined one of the first or the second pace/sense electrodes and the indifferent pace/sense electrode, and delivering a second ventricular pacing pulse between the predetermined other one of the first or the second pace/sense electrodes and the indifferent pace/sense electrode.

6. The method of claim 1, further comprising the step of:

at the time-out of the ventricular escape interval, generating and delivering a ventricular pacing pulse to a selected one or both of the first and second spaced apart sites employing a respective one of said first and second pace/sense electrodes; and

restarting the timing out of the ventricular escape interval and the trigger pace window.

7. A cardiac pacemaker for delivering first and second pacing pulses to a ventricle of a heart comprising:

ventricular lead means for locating first and second pace/sense electrodes at first and second spaced apart ventricular sites;

sensing means for sensing spontaneous ventricular cardiac depolarizations traversing one or the other of the first and second pace/sense electrodes and providing a ventricular sense event signal;

timing means operable upon provision of a sense event signal for starting and timing out a ventricular escape interval and a trigger pace window that is shorter than the ventricular escape interval;

pacing pulse generating means operable in a triggered pacing mode, upon provision of a ventricular sense event during the timing out of the ventricular escape interval following the time-out of the trigger pace window, for generating and delivering a ventricular pacing pulse or pacing pulses to a selected one or both of the first and second spaced apart ventricular sites through a respective one or both of said first and second pace/sense electrodes; and

means for disabling the triggered pace mode upon provision of a ventricular sense event during the timing out of the ventricular escape interval and the trigger pace window.

8. The pacemaker of claim 7, wherein the sensing means further comprises a single ventricular sense amplifier coupled to the first and second pace/sense electrodes for sensing depolarizations traversing one or the other of the first and second spaced apart sites.

9. The pacemaker of claim 7, wherein the triggered pacing mode is effected by:

first pacing pulse generating means responsive to provision of a ventricular sense event during the timing out of the ventricular escape interval for delivering a first ventricular pacing pulse to a predetermined one of the first or the second pace/sense electrodes to pace the ventricle at the site of that pace/sense electrode;

a triggered pacing delay timer operable upon provision of a ventricular sense event signal commencing and timing out a triggered pacing delay; and

second pacing pulse generating means responsive to the time-out of the triggered pacing delay for delivering a second ventricular pacing pulse to the other of the first or the second pace/sense electrodes to pace the ventricle at the site of that pace/sense electrode,

whereby a synchronized depolarization of the ventricle in a predetermined sequence is effected by the first and second pacing pulses.

10. The pacemaker of claim 7, wherein the triggered pacing mode is effected by:

first pacing pulse generating means responsive to provision of a ventricular sense event during the timing out of the ventricular escape interval for delivering a first ventricular pacing pulse to a predetermined one of the first or the second pace/sense electrodes to pace the ventricle at the site of that pace/sense electrode regardless of whether the ventricular sense event signal originates from a spontaneous ventricular cardiac depolarization detected at the first or second spaced apart ventricular sites;

a triggered pacing delay timer operable upon provision of a ventricular sense event signal commencing and timing out a triggered pacing delay; and

second pacing pulse generating means responsive to the time-out of the triggered pacing delay for delivering a second ventricular pacing pulse to the other of the first or the second pace/sense electrodes to pace the ventricle at the site of that pace/sense electrode,

whereby a synchronized depolarization of the heart in a predetermined sequence is effected by the first and second pacing pulses.

11. The pacemaker of claim 7, further comprising:

means for locating an indifferent pace/sense electrode in relation to the heart; and

wherein;

the sensing means further comprises a single ventricular sense amplifier coupled to the first and second pace/sense electrodes to sense depolarizations traversing one or the other of the first and second spaced apart sites; and

the pacing pulse generating means comprises means for delivering a pacing pulse in the triggered pacing mode comprises delivering a first ventricular pacing pulse between the predetermined one of the first or the second pace/sense electrodes and the indifferent pace/sense electrode, and delivering a second ventricular pacing pulse between the predetermined other one of the first or the second pace/sense electrodes and the indifferent pace/sense electrode.

12. The pacemaker of claim 7, wherein:

the pacing pulse generating means is responsive to the time-out of the ventricular escape interval for generating and delivering a ventricular pacing pulse to a selected one or both of the first and second spaced apart sites employing a respective one of said first and second pace/sense electrodes; and

the timing means is operable upon time-out of the ventricular escape interval to restart the timing out of a succeeding ventricular escape interval and trigger pace window.

13. In a cardiac pacemaker, a method of delivering triggered pacing pulses to right and left heart chambers comprising the steps of:

locating a right heart chamber pace/sense electrode at a right heart chamber site;

locating a left heart chamber pace/sense electrode at a left heart chamber site;

sensing spontaneous cardiac depolarizations traversing one or the other of the right and left heart chamber pace/sense electrodes and providing a sense event signal;

upon provision of a sense event signal, starting and timing out an escape interval and a trigger pace window that is shorter than the escape interval;

in a triggered pacing mode, upon provision of a sense event during the timing out of the escape interval following the time-out of the trigger pace window, generating and delivering a pacing pulse or pacing pulses to a selected one or both of the right and left heart chamber sites through a respective one or both of said right and left heart chamber pace/sense electrodes; and

disabling the triggered pace mode upon provision of a sense event during the timing out of the escape interval and the trigger pace window.

14. The method of claim 13, wherein the triggered pacing mode comprises the steps of:

upon provision of a sense event during the timing out of the escape interval, delivering a first pacing pulse to a predetermined one of the right or left heart chamber pace/sense electrodes to pace the heart at the right or left heart chamber site;

upon provision of a sense event signal commencing and timing out a triggered pacing delay; and

at the time-out of the triggered pacing delay, delivering a second pacing pulse to the other of the right or left heart chamber pace/sense electrodes to pace the heart at the other right or left heart chamber site;

whereby a synchronized depolarization of the heart in a predetermined right-to-left or left-to-right sequence is effected by the right and left heart chamber pacing pulses.

15. The method of claim 14, wherein the sensing step further comprises the step of:

coupling a single sense amplifier to the right and left heart chamber pace/sense electrodes for sensing depolarizations traversing one or the other of the right and left heart chamber sites.

16. The method of claim 13, wherein the triggered pacing mode comprises the steps of:

upon provision of a sense event during the timing out of the escape interval, delivering a first pacing pulse to a predetermined one of the right or left heart chamber pace/sense electrodes to pace the right or left heart chamber site regardless of whether the sense event signal originates from a spontaneous cardiac depolarization detected at the right or left heart chamber sites;

upon provision of a sense event signal commencing and timing out a triggered pacing delay; and

at the time-out of the triggered pacing delay, delivering a second pacing pulse to the other of the right or left heart chamber pace/sense electrodes to pace the heart at the other of the right or left heart chamber site;

whereby a synchronized depolarization of the heart in a predetermined right-to-left or left-to-right sequence is effected by the right and left heart chamber pacing pulses.

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

at the time-out of the escape interval, generating and delivering a pacing pulse to a selected one or both of the right and left heart chamber sites employing a respective one of said right and left heart chamber pace/sense electrodes; and

restarting the timing out an escape interval and the trigger pace window.

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

locating an indifferent pace/sense electrode in relation to the heart; and

wherein;

the sensing step further comprises the step of coupling a single sense amplifier to the right and left heart chamber pace/sense electrodes to sense depolarizations traversing one or the other of the right and left heart chamber sites; and

the step of delivering a pacing pulse in the triggered pacing mode comprises delivering a first pacing pulse between a predetermined one of the right or left heart chamber pace/sense electrodes and the indifferent pace/sense electrode, and delivering a second pacing pulse between a predetermined other one of the right or left heart chamber pace/sense electrodes and the indifferent pace/sense electrode.

19. The method of claim 13, wherein the right and left heart chambers comprise right and left ventricles.

20. In a cardiac pacemaker, for delivering right and left heart chamber pacing pulses to a heart comprising:

lead means for locating right and left heart chamber pace/sense electrodes at spaced apart right and left heart chamber sites;

sensing means for sensing spontaneous cardiac depolarizations traversing one or the other of the right and left heart chamber pace/sense electrodes and providing a sense event signal;

timing means operable upon provision of a sense event signal for starting and timing out an escape interval and a trigger pace window that is shorter than the escape interval;

pacing pulse generating means operable in a triggered pacing mode, upon provision of a sense event during the timing out of the escape interval following the time-out of the trigger pace window, for generating and delivering a pacing pulse or pacing pulses to a selected one or both of the right and left heart chamber sites through a respective one of said right and left heart chamber pace/sense electrodes; and

means for disabling the triggered pace mode upon provision of a sense event during the timing out of the escape interval and the trigger pace window.

21. The pacemaker of claim 20, wherein the triggered pacing mode is effected by:

first pacing pulse generating means responsive to provision of a sense event during the timing out of the escape interval for delivering a first pacing pulse to a predetermined one of the right or left heart chamber pace/sense electrodes to pace the right or left heart chamber site;

a triggered pacing delay timer operable upon provision of a sense event signal commencing and timing out a triggered pacing delay; and

second pacing pulse generating means responsive to the time-out of the triggered pacing delay for delivering a second pacing pulse to the other of the right or left heart chamber pace/sense electrodes to pace the other of the right or left heart chamber sites;

whereby a synchronized depolarization of the heart in a predetermined right-to-left or left-to-right sequence is effected by the right and left heart chamber pacing pulses.

22. The pacemaker of claim 20, further comprising:

means for locating an indifferent pace/sense electrode in relation to the heart; and

wherein;

the sensing means further comprises a single sense amplifier coupled to the right and left heart chamber pace/sense electrodes to sense depolarizations traversing one or the other of the right and left heart chamber sites; and

the pacing pulse generating means comprises means for delivering a pacing pulse in the triggered pacing mode comprises delivering a first pacing pulse between a predetermined one of the right or left heart chamber pace/sense electrodes and the indifferent pace/sense electrode, and delivering a second pacing pulse between a predetermined other one of the right or left heart chamber pace/sense electrodes and the indifferent pace/sense electrode.

23. The pacemaker of claim 20, wherein the triggered pacing mode is effected by:

first pacing pulse generating means responsive to provision of a sense event during the timing out of the escape interval for delivering a first pacing pulse to a predetermined one of the right or left heart chamber pace/sense electrodes to pace that right or left heart chamber site regardless of whether the sense event signal originates from a spontaneous cardiac depolarization detected at the right or left heart chamber site;

a triggered pacing delay timer operable upon provision of a sense event signal commencing and timing out a triggered pacing delay; and

second pacing pulse generating means responsive to the time-out of the triggered pacing delay for delivering a second pacing pulse to the other of the right or left heart chamber pace/sense electrodes to pace the other of the right or left heart chamber sites;

whereby a synchronized depolarization of the heart in a predetermined right-to-left or left-to-right sequence is effected by the right and left heart chamber pacing pulses.

24. The pacemaker of claim 20, wherein the sensing means further comprises a single sense amplifier coupled to the right and left heart chamber pace/sense electrodes for sensing depolarizations traversing one or the other of the right and left heart chamber sites.

25. The pacemaker of claim 20, wherein the right and left heart chambers comprise right and left ventricles.

26. The pacemaker of claim 20, wherein:

the pacing pulse generating means is responsive to the time-out of the escape interval for generating and delivering a pacing pulse to a selected one or both of the right and left heart chamber sites employing a respective one of said right and left heart chamber pace/sense electrodes; and

the timing means is operable upon time-out of the escape interval to restart the timing out of a succeeding escape interval and trigger pace window.