System and method for managing refractory periods in a cardiac rhythm management device with biventricular sensing

• US 6,553,258 B2
• Filed: 12/26/2000
• Issued: 04/22/2003
• Est. Priority Date: 12/26/2000
• Status: Expired due to Term

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: DiCarlo, Lorenzo, Gilkerson, James O., Stahmann, Jeffrey E., Kramer, Andrew P., Wentkowski, Rene H.
• Primary Examiner(s): Schaetzle, Kennedy
• Application Number:
  US09/748,733
• Publication Number:
  US 20020082653A1
• Time in Patent Office: 847 Days
• Field of Search: 607/9, 607/15, 607/148
• US Class Current: 607/9
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/3684 for stimulating the heart at multiple sites of the ventricle or the atrium
• CPC Class Codes: A61N 1/36842 Multi-site stimulation in the same chamber
• CPC Class Codes: A61N 1/36843 Bi-ventricular stimulation

Abstract

A method and system for managing refractory periods in a cardiac rhythm management device configured for biventricular or biatrial sensing. Refractory periods for each channel of the pacemaker are provided by interval timers that are triggered by sensed or paced events in order to prevent misinterpretation of sensing signals.

Claims

1. A method for operating a cardiac rhythm management device, comprising:

sensing a rate chamber and a synchronized chamber through separate channels and generating sense signals upon detection of depolarization occurring in a chamber;

pacing the synchronized chamber upon expiration of an escape interval without receipt of a rate chamber sense signal from the rate chamber sensing channel;

rendering each sensing channel refractory for a separately selected pacing refractory period after a pacing event; and

,

rendering a sensing channel refractory for a selected sensing refractory period after receipt of a sense signal from that channel while continuing to sense in the other channel.

2. The method of claim 1 wherein the rate and synchronized chambers are ventricles, designated as the ventricular rate chamber and the ventricular synchronized chamber.

3. The method of claim 2 further comprising;

sensing an atrium through a separate atrial channel and generating an atrial sense signal upon detection of depolarization occurring in the atrium;

pacing a ventricle upon expiration of a selected atrioventricular time interval without receipt of a ventricular rate chamber sense signal from the ventricular rate chamber sensing channel, where the atrioventricular time interval starts with receipt of an atrial sense signal;

rendering the atrial sensing channel refractory for a selected pacing refractory period after a ventricular pacing event; and

,

rendering the atrial sensing channel refractory for a selected sensing refractory period after a ventricular rate chamber sensing signal but continuing to sense in the atrial channel following a ventricular synchronized chamber sensing signal.

4. The method of claim 3 further comprising:

pacing an atrium upon expiration of a selected atrial escape interval without receipt of an atrial sense signal, where the atrial escape interval starts with either receipt of a ventricular rate chamber sense signal or a ventricular pacing event; and

,

rendering the atrial and both ventricular sensing channels refractory for separately selected periods of time after an atrial pacing event.

5. The method of claim 3 further comprising rendering the atrial sensing channel refractory for a selected period of time after an atrial sense.

6. The method of claim 3 further comprising rendering the ventricular synchronized chamber sensing channel refractory for a selected period of time after an atrial sense.

7. The method of claim 1 wherein the rate and synchronized chambers are atria.

8. The method of claim 1 wherein the rate and synchronized chambers are sensing/pacing sites in the same heart chamber.

9. The method of claim 1 further comprising sensing a plurality of synchronized sensing/pacing sites in the synchronized chamber through separate channels and generating sense signals upon detection of depolarization occurring at each site.

10. The method of claim 9 further comprising pacing a plurality of synchronized sensing/pacing sites in the synchronized chamber through separate channels.

11. The method of claim 1 further comprising pacing the rate chamber upon expiration of an escape interval without receipt of a rate chamber sense signal from the rate chamber sensing channel.

12. The method of claim 1 wherein the rate and synchronized chambers are ventricles designated as the rate ventricle and synchronized ventricle, respectively, and further comprising:

sensing an atrium through a separate atrial channel and generating an atrial sense signal upon detection of depolarization occurring in the atrium; and

,

wherein the escape interval is an atrioventricular interval which starts with receipt of an atrial sense signal.

13. The method of claim 1 further comprising pacing both chambers upon expiration of an escape interval without receipt of a rate chamber sense signal from the rate chamber sensing channel.

14. The method of claim 13 wherein the chambers are paced with a selected synchronized chamber channel offset interval.

15. The method of claim 14 wherein the pacing refractory period of each chamber begins with pacing of the earlier paced chamber.

16. The method of claim 15 wherein a minimum refractory period is maintained in the later paced chamber after the later pace.

17. The method of claim 1 wherein a sense in one chamber triggers a pace in the other chamber.

18. The method of claim 17 wherein the pacing refractory period of both chambers begins when the paced chamber receives the pace.

19. A cardiac rhythm management device, comprising:

separate sensing channels for sensing a rate chamber and a synchronized chamber and generating sense signals upon detection of depolarization occurring in a chamber;

a pacing channel for delivering pacing pulses to the synchronized chamber upon expiration of an escape interval without receipt of a rate chamber sense signal from the rate chamber sensing channel;

a controller for controlling the delivery of paces in accordance with a programmed pacing mode;

a pacing refractory period timer for rendering each sensing channel refractory for a selected period of time after a pacing event; and

,

a sensing refractory period timer for rendering the rate chamber sensing channel refractory for a selected period of time after receipt of a rate chamber sense signal without affecting the synchronized chamber sensing channel.

20. The device of claim 19 wherein the rate and synchronized chambers are ventricles, designated as the ventricular rate chamber and the ventricular synchronized chamber.

21. The device of claim 20 further comprising;

an atrial sensing channel for sensing atrial depolarizations and generating atrial sense signals in accordance therewith;

an atrioventricular timer for triggering a ventricular pace upon expiration of a selected atrioventricular time interval without receipt of a ventricular rate chamber sense signal from the ventricular rate chamber sensing channel, where the atrioventricular timer is reset upon receipt of an atrial sense signal;

a refractory period timer for rendering the atrial sensing channel refractory for a selected pacing refractory period after a ventricular pacing event; and

,

a refractory period timer and logic circuitry for rendering the atrial sensing channel refractory for a selected sensing refractory period after a ventricular rate chamber sensing signal, wherein the atrial sensing channel continues to sense following a ventricular synchronized chamber sensing signal.

22. The device of claim 21 further comprising:

an atrial pacing channel for delivering paces to an atrium;

wherein the controller is programmed to deliver paces to the atrium in accordance with an atrial pacing mode; and

,

pacing refractory period timers for rendering the atrial and both ventricular sensing channels refractory for selected refractory periods after an atrial pacing event.

23. The device of claim 19 wherein the rate and synchronized chambers are atria.

24. The device of claim 19 wherein the rate and synchronized chambers are sensing/pacing sites in the same heart chamber.

25. The device of claim 19 further comprising separate channels for sensing a plurality of synchronized sensing/pacing sites in the synchronized chamber and generating sense signals upon detection of depolarization occurring at each site.

26. The device of claim 19 further comprising separate channels for pacing a plurality of synchronized sensing/pacing sites in the synchronized chamber.

27. The device of claim 19 further comprising a second pacing channel for delivering paces to the rate chamber.

28. The device of claim 27 wherein the controller is programmed to pace one chamber upon expiration an escape interval and pace the other chamber within a selected synchronized chamber offset interval.

29. The device of claim 28 wherein the pacing refractory period timer for each chamber is reset upon pacing of the earlier paced chamber.

30. The device of claim 28 wherein the pacing refractory period timers for both ventricles are reset upon pacing of the earlier paced ventricle.

31. The device of claim 27 wherein the controller is programmed to pace the synchronized chamber within a latency period after receipt of a rate chamber sense signal.

32. The device of claim 31 wherein the pacing refractory period timers for both chambers are reset after the pace is delivered.

33. The device of claim 27 wherein the controller is programmed to pace both chambers within a latency period after receipt of a rate chamber sense signal.