Method and system for preventing atrial fibrillation by rapid pacing intervention

• US 6,650,938 B2
• Filed: 04/27/2001
• Issued: 11/18/2003
• Est. Priority Date: 04/27/2001
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Boute, Willem
• Primary Examiner(s): Vo, Hieu T.
• Assistant Examiner(s): Hoang, Johnny H.
• Application Number:
  US09/842,878
• Publication Number:
  US 20030009198A1
• Time in Patent Office: 935 Days
• Field of Search: 607/9, 607/14, 607/25, 607/2, 607/30, 607/17, 607/40, 607/27, 607/6
• US Class Current: 607/14
• CPC Class Codes: A61N 1/3622 comprising two or more electrodes co-operating with different heart regions

Abstract

A method of pacing cardiac tissue using an implantable medical device is provided. A first fibrillation-indicative interval is determined based on a first fibrillation-indicative event. A first adjusted pacing interval, wherein the first adjusted pacing interval is shorter than the first fibrillation-indicative interval, is determined and the cardiac tissue is paced based on the first adjusted pacing interval. If the cardiac tissue is not captured by pacing at the first adjusted pacing interval, an additional fibrillation-indicative interval is determined based on an additional earlier fibrillation-indicative event. An additional adjusted pacing interval, wherein the additional adjusted pacing interval is shorter than the additional fibrillation-indicative interval is determined and the cardiac tissue is paced based on the additional adjusted pacing interval.

Claims

1. A method of pacing cardiac tissue using an implantable medical device, comprising:

determining a first fibrillation-indicative interval based on a first fibrillation indicative event;

determining a first adjusted pacing interval, wherein the first adjusted pacing interval is shorter than the first fibrillation-indicative interval;

pacing the cardiac tissue based on the first adjusted pacing interval;

determining if the cardiac tissue is captured by pacing at the first adjusted pacing interval;

if the cardiac tissue is not captured, determining an additional fibrillation indicative interval based on an additional earlier fibrillation-indicative event;

determining an additional adjusted pacing interval, wherein the additional adjusted pacing interval is shorter than the additional fibrillation-indicative interval; and

pacing the cardiac tissue based on the additional adjusted pacing interval to reduce atrial fibrillation.

2. The method of claim 1, further comprising:

pacing the cardiac tissue based on an initial pacing interval.

3. The method of claim 1 wherein the additional adjusted pacing interval is shorter than the first adjusted pacing interval.

4. The method of claim 1 further comprising:

detecting the first fibrillation-indicative event.

5. The method of claim 1 further comprising:

detecting the additional earlier fibrillation-indicative event.

6. The method of claim 1 wherein the fibrillation-indicative event is a premature atrial contraction.

7. The method of claim 1 further comprising:

determining a decay pacing interval.

8. The method of claim 7 further comprising:

pacing the cardiac tissue at the decay pacing interval.

9. The method of claim 1 further comprising:

determining a minimum atrial pacing interval.

10. The method of claim 9 wherein the first adjusted pacing interval is less than the minimum atrial pacing interval, further comprising:

pacing the cardiac tissue at the minimum atrial pacing interval.

11. The method of claim 9 wherein the additional adjusted pacing interval is less than the minimum atrial pacing interval, further comprising:

pacing the cardiac tissue at the minimum atrial pacing interval.

12. A method of pacing cardiac tissue using an implantable medical device, comprising:

detecting a first premature atrial contraction, the first premature atrial contraction having a first coupling interval;

calculating a first adjusted pacing interval based on the first coupling interval, wherein the first adjusted pacing interval is shorter than the first coupling interval;

adjusting an initial pacing interval of the cardiac tissue to the first adjusted pacing interval;

detecting a second premature atrial contraction, the second premature atrial contraction having a second coupling interval;

calculating a second adjusted pacing interval based on the second coupling interval, wherein the second adjusted pacing interval is shorter than the second coupling interval; and

further adjusting the first adjusted pacing interval to the second adjusted pacing interval.

13. The method of claim 12 further comprising:

reducing the second adjusted pacing interval to a decay pacing interval.

14. The method of claim 13 further comprising:

determining the decay pacing interval based on the second adjusted pacing interval.

15. The method of claim 12 further comprising:

determining a minimum atrial pacing interval; and

adjusting the initial pacing interval to the minimum atrial pacing interval when the first adjusted pacing interval is less than the minimum atrial pacing interval.

16. The method of claim 12 further comprising:

determining a minimum atrial pacing interval; and

adjusting the first adjusted pacing interval to the minimum atrial pacing interval when the second adjusted pacing interval is less than the minimum atrial pacing interval.

17. The method of claim 12 further comprising:

pacing the cardiac tissue at the initial pacing interval.

18. An implantable medical device, comprising:

a processor;

at least one pacing circuit operably connected to the processor; and

at least one pacing electrode wherein a first premature atrial contraction having a first coupling interval is detected;

a first adjusted pacing interval which is shorter than the first coupling interval is calculated based on the first coupling interval;

an initial pacing interval is adjusted to the first adjusted pacing interval;

a second premature atrial contraction having a second coupling interval is detected;

a second adjusted pacing interval which is shorter than the second coupling interval is calculated based on the second coupling interval; and

the first adjusted pacing interval is further adjusted to the second adjusted pacing interval.

19. The device of claim 18, further comprising:

a memory location operably connected to the processor for storing the first coupling interval.

20. The device of claim 18, further comprising:

a memory location operably connected to the processor for storing the second coupling interval.

21. The device of claim 18, further comprising:

a memory location operably connected to the processor for storing the first adjusted pacing interval.

22. The device of claim 18, further comprising:

a memory location operably connected to the processor for storing the 15 second adjusted pacing interval.

23. The device of claim 18, further comprising:

a memory location operably connected to the processor for storing a minimum atrial pacing interval.

24. An implantable medical system, comprising:

means for determining a first fibrillation-indicative interval based on a first fibrillation-indicative event;

means for determining a first adjusted pacing interval, wherein the first adjusted pacing interval is shorter than the first fibrillation-indicative interval;

means for pacing the cardiac tissue based on the first adjusted pacing interval;

means for determining if the cardiac tissue is captured by pacing at the first adjusted pacing interval;

if the cardiac tissue is not captured, means for determining an additional fibrillation-indicative interval based on an additional earlier fibrillation-indicative event;

means for determining an additional adjusted pacing interval, wherein the additional adjusted pacing interval is shorter than the additional fibrillation indicative interval; and

means for pacing the cardiac tissue based on the additional adjusted pacing interval to reduce atrial fibrillation.

25. The system of claim 24, further comprising:

means for pacing the cardiac tissue based on an initial pacing interval.

26. The system of claim 24, further comprising:

means for detecting the first fibrillation-indicative event.

27. The system of claim 24, further comprising:

means for detecting the additional earlier fibrillation-indicative event.

28. The system of claim 24, further comprising:

means for determining a decay pacing interval.

29. The system of claim 28, further comprising:

means for pacing the cardiac tissue at the decay pacing interval.

30. The system of claim 24, further comprising:

means for determining a minimum atrial pacing interval.

31. The system of claim 30, wherein the first adjusted pacing interval is less than the minimum atrial pacing interval, further comprising:

means for pacing the cardiac tissue at the minimum atrial pacing interval.

32. The system of claim 30, wherein the additional adjusted pacing interval is less than the minimum atrial pacing interval, further comprising:

means for pacing the cardiac tissue at the minimum atrial pacing interval.

33. An implantable medical system, comprising:

means for detecting a first premature atrial contraction, the first premature atrial contraction having a first coupling interval;

means for calculating a first adjusted pacing interval based on the first coupling interval, wherein the first adjusted pacing interval is shorter than the first coupling interval;

means for adjusting an initial pacing interval of the cardiac tissue to the first adjusted pacing interval;

means for detecting a second premature atrial contraction, the second premature atrial contraction having a second coupling interval;

means for calculating a second adjusted pacing interval based on the second coupling interval, wherein the second adjusted pacing interval is shorter than the second coupling interval; and

means for further adjusting the first adjusted pacing interval to the second adjusted pacing interval.

34. The system of claim 33 further comprising:

means for reducing the second adjusted pacing interval to a decay pacing interval.

35. The system of claim 34 further comprising:

means for determining the decay pacing interval based on the second adjusted pacing interval.

36. The system of claim 33 further comprising:

means for determining a minimum atrial pacing interval; and

means for adjusting the initial pacing interval to the minimum atrial pacing interval when the first adjusted pacing interval is less than the minimum atrial pacing interval.

37. The system of claim 33 further comprising:

means for determining a minimum atrial pacing interval; and

means for adjusting the first adjusted pacing interval to the minimum atrial pacing interval when the second adjusted pacing interval is less than the minimum atrial pacing interval.

38. The system of claim 33 further comprising:

means for pacing the cardiac tissue at the initial pacing interval.

39. A computer usable medium including a program for pacing cardiac tissue, comprising:

computer program code that determines a first fibrillation-indicative interval based on a first fibrillation-indicative event;

computer program code that determines a first adjusted pacing interval, wherein the first adjusted pacing interval is shorter than the first fibrillation-indicative interval;

computer program code that paves the cardiac tissue based on the first adjusted pacing interval;

computer program code that determines if the cardiac tissue is captured by pacing at the first adjusted pacing interval;

if the cardiac tissue is not captured, computer program code that determines an additional fibrillation-indicative interval based on an additional earlier fibrillation-indicative event;

computer program code that determines an additional adjusted pacing interval, wherein the additional adjusted pacing interval is shorter than the additional fibrillation-indicative interval; and

computer program code that paces the cardiac tissue based on the additional adjusted pacing interval.

40. The program of claim 39, further comprising:

computer program code that paces the cardiac tissue based on an initial pacing interval.

41. The program of claim 39, further comprising;

computer program code that detects the first fibrillation-indicative event.

42. The program of claim 39, further comprising:

computer program code that detects the additional earlier fibrillationindicative event.

43. The program of claim 39, further comprising:

computer program code that determines a decay pacing interval.

44. The program of claim 43, further comprising:

computer program code that paces the cardiac tissue at the decay pacing interval.

45. The program of claim 39, further comprising:

computer program code that determines a minimum atrial pacing interval.

46. The program of claim 45, wherein the first adjusted pacing interval is less than the minimum atrial pacing interval, further comprising:

computer program code that paces the cardiac tissue at the minimum atrial pacing interval.

47. The program of claim 45, wherein the additional adjusted pacing interval is less than the minimum atrial pacing interval, further comprising:

computer program code that paces the cardiac tissue at the minimum atrial pacing interval.

48. A computer usable medium including a program for pacing cardiac tissue, comprising:

computer program code that detects a first premature atrial contraction, the first premature atrial contraction having a first coupling interval;

computer program code that calculates a first adjusted pacing interval based on the first coupling interval, wherein the first adjusted pacing interval is shorter than the first coupling interval;

computer program code that adjusts an initial pacing interval of the cardiac tissue to the first adjusted pacing interval;

computer program code that detects a second premature atrial contraction, the second premature atrial contraction having a second coupling interval;

computer program code that calculates a second adjusted pacing interval based on the second coupling interval, wherein the second adjusted pacing interval is shorter than the second coupling interval; and

computer program code that further adjusts the first adjusted pacing interval to the second adjusted pacing interval.

49. The program of claim 48 further comprising:

computer program code that reduces the second adjusted pacing interval to a decay pacing interval.

50. The program of claim 49 further comprising:

computer program code that determines to decay pacing interval based on the second adjusted pacing interval.

51. The program of claim 48 further comprising:

computer program code that determines a minimum atrial pacing interval; and

computer program code that adjusts the initial pacing interval to the minimum atrial pacing interval when the first adjusted pacing interval is less than the minimum atrial pacing interval.

52. The program of claim 48 further comprising:

computer program code that determines a minimum atrial pacing interval;

computer program code that adjusts the first adjusted pacing interval to the minimum atrial pacing interval when the second adjusted pacing interval is less than the minimum atrial pacing interval.

53. The program of claim 48 further comprising:

computer program code that paces the cardiac tissue at the initial pacing interval.