Methods and apparatus for overdrive pacing heart tissue using an implantable cardiac stimulation device
First Claim
1. A method for controlling overdrive pacing of a patient'"'"'s heart using an implantable cardiac stimulation device connected to the heart, the method comprising the steps of:
- determining an overdrive pacing rate;
overdrive pacing the heart at the overdrive pacing rate;
detecting intrinsic heart beats arising during the overdrive pacing; and
if at least two intrinsic heart beats are detected within a first determined search period, increasing the overdrive pacing rate by a determined rate increment; and
if at least two intrinsic heart beats are not detected within a second determined search period, decreasing the overdrive pacing rate by a determined rate decrement.
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Abstract
Techniques are described for overdrive pacing the heart using a pacemaker wherein the overdrive pacing rate only increases when at least two intrinsic beats are detected within a determined search period. In one specific technique, an increase in the pacing rate occurs only if two P-waves are detected within X cardiac cycles. In another specific technique, the overdrive pacing rate is increased only if at least two P-waves are detected within a block of N cardiac cycles. In both techniques, the overdrive pacing rate is decreased if no increase has occurred in the last Z cardiac cycles. By increasing the overdrive pacing rate only in response to detection of at least two P-waves within a determined number of cardiac cycles, an excessively high overdrive pacing rate is avoided. Other techniques are described for adaptively adjusting overdrive pacing parameters so as to achieve a determined target degree of pacing of, for example, 95% paced beats. By adaptively adjusting overdrive parameters to maintain a target degree of pacing, the average overdrive pacing rate is minimized while still maintaining a high number of paced beats, thereby reducing the risk of a tachyarrhythmia occurring within the patient.
109 Citations
32 Claims
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1. A method for controlling overdrive pacing of a patient'"'"'s heart using an implantable cardiac stimulation device connected to the heart, the method comprising the steps of:
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determining an overdrive pacing rate;
overdrive pacing the heart at the overdrive pacing rate;
detecting intrinsic heart beats arising during the overdrive pacing; and
if at least two intrinsic heart beats are detected within a first determined search period, increasing the overdrive pacing rate by a determined rate increment; and
if at least two intrinsic heart beats are not detected within a second determined search period, decreasing the overdrive pacing rate by a determined rate decrement. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15)
determining a sinus rate; and
setting the overdrive pacing rate to be equal to the sinus rate.
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12. The method of claim 11 wherein the step of determining the sinus rate includes the steps of:
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detecting at least three consecutive sinus P-waves;
determining an average interval between the P-waves; and
calculating the sinus rate based upon the average interval.
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13. The method of claim 11 further including the step of periodically re-determining the overdrive pacing rate by:
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suspending overdrive pacing;
detecting at least three consecutive P-waves while overdrive pacing is suspended;
determining an updated sinus rate based upon the at least three consecutive P-waves; and
setting the overdrive pacing rate based upon the updated sinus rate.
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14. The method of claim 1 wherein the step of determining the overdrive pacing rate includes the steps of:
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determining an atrial rate; and
setting the overdrive pacing rate to be equal to the atrial rate.
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15. The method of claim 14 further including the steps of:
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periodically determining an updated atrial rate;
comparing the updated atrial rate with a current overdrive pacing rate; and
if the updated atrial rate exceeds the current overdrive pacing rate by a determined amount, resetting the overdrive pacing rate to be equal to the updated atrial rate.
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16. A system for controlling overdrive pacing of a heart using an implantable cardiac stimulation device configured for connection to a patient'"'"'s heart, the system comprising:
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means for determining an overdrive pacing rate;
means for overdrive pacing the heart at the overdrive pacing rate;
means for detecting intrinsic heart beats arising during the overdrive pacing;
means, responsive to detection of at least two intrinsic heart beats within a first determined search period, for increasing the overdrive pacing rate by a determined rate increment; and
means, responsive to detection of no more than one intrinsic heart beat within a second determined search period, for decreasing the overdrive pacing rate by a determined rate decrement.
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17. A system for controlling overdrive pacing of a patient'"'"'s heart using an implantable cardiac stimulation device configured for connection to the heart, the system comprising:
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a determination unit determining an overdrive pacing rate;
an overdrive pacing unit for overdrive pacing the patient'"'"'s heart at the overdrive pacing rate;
a detection unit for detecting intrinsic heart beats arising during the overdrive pacing;
an overdrive pacing rate increment unit for increasing the overdrive pacing rate by a determined rate increment in response to detection of at least two intrinsic heart beats within a first determined search period; and
wherein the overdrive pacing rate increment unit decreases the overdrive pacing rate by a determined rate decrement in response to detection of no more than one intrinsic heart beat within a second determined search period.
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18. A method for controlling overdrive pacing of a patient'"'"'s heart using an implantable cardiac stimulation device connected to the heart, the method comprising the steps of:
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determining an overdrive pacing rate;
overdrive pacing the heart at the overdrive pacing rate;
detecting intrinsic heart beats arising during the overdrive pacing; and
if at least two intrinsic heart beats are detected within a first determined search period, increasing the overdrive pacing rate by a determined rate increment; and
if no intrinsic heart beats are detected within a second determined search period, decreasing the overdrive pacing rate by a determined rate decrement. - View Dependent Claims (19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32)
inputting a target value representative of a target degree of pacing;
comparing the actual degree of pacing with the target degree of pacing; and
adjusting the control values to reduce a difference, if any, between the actual degree of pacing and the target degree of pacing.
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23. The method of claim 22 wherein the first determined search period is 10 cycles.
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24. The method of claim 18 wherein the second determined search period begins following an increase in the overdrive pacing rate.
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25. The method of claim 24 wherein the second determined search period is between 8 and 40 cycles, inclusive.
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26. The method of claim 18 wherein the determined rate increment is selected from a group including 5, 10, 15, 20, and 25 ppm.
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27. The method of claim 18 wherein the determined rate decrement is selected from a group including 1, 2, 3, 4, and 5 ppm.
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28. The method of claim 18 wherein the step of determining the overdrive pacing rate includes the steps of:
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determining a sinus rate; and
setting the overdrive pacing rate to be equal to the sinus rate.
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29. The method of claim 28 wherein the step of determining the sinus rate includes the steps of:
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detecting at least three consecutive sinus P-waves;
determining an average interval between the P-waves; and
calculating the sinus rate based upon the average interval.
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30. The method of claim 28 further including the step of periodically re-determining the overdrive pacing rate by:
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suspending overdrive pacing;
detecting at least three consecutive P-waves while overdrive pacing is suspended;
determining an updated sinus rate based upon the at least three consecutive P-waves; and
setting the overdrive pacing rate based upon the updated sinus rate.
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31. The method of claim 18 wherein the step of determining the overdrive pacing rate includes the steps of:
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determining an atrial rate; and
setting the overdrive pacing rate to be equal to the atrial rate.
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32. The method of claim 31 further including the steps of:
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periodically determining an updated atrial rate;
comparing the updated atrial rate with a current overdrive pacing rate; and
if the updated atrial rate exceeds the current overdrive pacing rate by a determined amount, resetting the overdrive pacing rate to be equal to the updated atrial rate.
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Specification