Permanent atrial-his-ventricular sequential pacing

• US 6,718,206 B2
• Filed: 10/23/2001
• Issued: 04/06/2004
• Est. Priority Date: 10/23/2001
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Casavant, David A.
• Primary Examiner(s): Layno, Carl
• Application Number:
  US10/047,632
• Publication Number:
  US 20030078625A1
• Time in Patent Office: 896 Days
• Field of Search: 607/9, 607/14, 607/15, 607/18, 607/25
• 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 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence

Abstract

A method and apparatus for cardiac pacing and, more particularly, for Atrial-His-Ventricular sequential pacing to improve sino-atrial node dysfunction or heart block superior to the His bundle. As a derivative, His-Ventricular sequential pacing can be employed to treat permanent atrial fibrillation.

Claims

1. A method of providing atrial-ventricular (AV) synchronous pacing to a heart through a dual chamber pacemaker pulse generator coupled with pacing leads extending to ventricular pace/sense electrodes disposed in operative relation to a ventricle, atrial pace/sense electrodes disposed in operative relation to an atrium, and His bundle pace electrodes disposed along the AV septum in operative relation to the bundle of His comprising the steps of:

determining the intrinsic AR interval of the patient'"'"'s heart by;

sensing at least one P-wave associated with depolarization of an atrium through the atrial pace/sense electrodes as an atrial sensed event;

sensing at least one R-waves associated with depolarizations of a ventricle through the ventricular pace/sense electrodes as a ventricular sensed event; and

timing an intrinsic AR interval from at least one pair of successive atrial and ventricular sensed events;

establishing an A-H delay as a function of the determined intrinsic AR interval;

establishing an AV delay that is shorter than the determined intrinsic AR interval; and

synchronously pacing the patient'"'"'s heart by;

establishing an atrial pacing escape interval;

timing out the atrial pacing escape interval;

sensing P-waves associated with depolarizations of the atrium through the atrial pace/sense electrodes as atrial sensed events;

restarting the atrial pacing escape interval on the sensing of an atrial sensed event within said atrial pacing escape interval;

delivering an atrial pace pulse through the atrial pace/sense electrodes to the atrium at the time out of the atrial pacing escape interval;

timing out the A-H delay from an atrial sensed event or delivery of an atrial pace pulse;

delivering a His bundle pacing pulse through the His bundle pace electrodes to the bundle of His upon time-out of the A-H delay;

timing out the AV delay from an atrial sensed event or delivery of an atrial pace pulse;

sensing R-waves associated with depolarizations of the ventricle through the ventricular pace/sense electrodes as ventricular sensed events;

halting the time-out of the AV delay upon a ventricular sensed event occurring during time-out of the AV delay; and

delivering a ventricular pacing pulse through the ventricular pace/sense electrodes upon time-out of the AV delay;

wherein the step of establishing an A-H delay as a function of the determined intrinsic AR interval comprises setting the A-H delay to be shorter than the AV delay.

2. A method of providing atrial-ventricular (AV) synchronous pacing to a heart through a dual chamber pacemaker pulse generator coupled with pacing leads extending to ventricular pace/sense electrodes disposed in operative relation to a ventricle, atrial pace/sense electrodes disposed in operative relation to an atrium, and His bundle pace electrodes disposed along the AV septum in operative relation to the bundle of His comprising the steps of:

determining the intrinsic AR interval of the patients heart by;

sensing at least one P-wave associated with depolarization of an atrium through the atrial pace/sense electrodes as an atrial sensed event;

sensing at least one R-wave associated with depolarizations of a ventricle through the ventricular pace/sense electrodes as a ventricular sensed event; and

timing an intrinsic AR interval from at least one air of successive atrial and ventricular sensed events;

establishing an A-H delay as a function of the determined intrinsic AR interval; and

synchronously pacing the patient'"'"'s heart by;

establishing an atrial pacing escape interval;

timing out the atrial pacing escape interval;

sensing P-waves associated with depolarizations of the atrium through the atrial pace/sense electrodes as atrial sensed events;

restarting the atrial pacing escape interval on the sensing of an atrial sensed event within said atrial pacing escape interval;

delivering an atrial pace pulse through the atrial pace/sense electrodes to the atrium at the time out of the atrial pacing escape interval;

timing out the A-H delay from an atrial sensed event or delivery of an atrial pace pulse; and

delivering a His bundle pacing pulse through the His bundle pace electrodes to the bundle of His upon time-out of the A-H delay;

wherein the step of establishing an A-H delay as a function of the determined intrinsic AR interval comprises setting the A-H delay to be shorter than the determined intrinsic AR interval.

3. A method of providing atrial-ventricular (AV) synchronous pacing to a heart through a dual chamber pacemaker pulse generator coupled with pacing leads extending to ventricular pace/sense electrodes disposed in operative relation to a ventricle atrial pace/sense electrodes disposed in operative relation to an atrium, and His bundle pace electrodes disposed along the AV septum in operative relation to the bundle of His comprising the steps of:

determining the intrinsic AR interval of the patient'"'"'s heart by;

sensing at least one P-wave associated with depolarization of an atrium through the atrial pacelsense electrodes as an atrial sensed event;

sensing at least one R-wave associated with depolarizations of a ventricle through the ventricular pace/sense electrodes as a ventricular sensed event; and

timing an intrinsic AR interval from at least one pair of successive atrial and ventricular sensed events;

establishing an A-H delay as a function of the determined intrinsic AR interval; and

synchronously pacing the patient'"'"'s heart by;

establishing an atrial pacing escape interval;

timing out the atrial pacing escape interval;

sensing P-waves associated with depolarizations of the atrium through the atrial pace/sense electrodes as atrial sensed events;

restarting the atrial pacing escape interval on the sensing of an atrial sensed event within said atrial pacing escape interval;

delivering an atrial pace pulse through the atrial pace/sense electrodes to the atrium at the time out of the atrial pacing escape interval;

timing out the A-H delay from an atrial sensed event or delivery of an atrial pace pulse; and

delivering a His bundle pacing pulse through the His bundle pace electrodes to the bundle of His upon time-out of the A-H delay;

wherein the step of establishing an A-H delay as a function of the determined intrinsic AR interval comprising setting the A-H delay to be longer than the determined intrinsic AR interval.

4. An atrial-ventricular (AV) synchronous pacing system that comprises a dual chamber pacemaker pulse generator coupled with pacing leads extending to ventricular pace/sense electrodes disposed in operative relation to a ventricle, atrial pace/sense electrodes disposed in operative relation to an atrium, and His bundle pace electrodes disposed along the AV septum in operative relation to the bundle of His, the pulse generator further comprising:

means for establishig an atrial pacing escape interval;

means for timing out the atrial pacing escape interval;

means for sensing P-waves associated with depolarizations of the atrium through the atrial pace/sense electrodes as atrial sensed events;

means for restarting the atrial pacing escape interval on the sensing of an atrial sensed event within said atrial pacing escape interval;

means for delivering an atrial pace pulse through the atrial pace/sense electrodes to the atrium at the time out of the atrial pacing escape interval;

means for timing out an A-H delay from an atrial sensed event or delivery of an atrial pace pulse;

means for delivering a His bundle pacing pulse through the His bundle pace electrodes to the bundle of His upon time-out of the A-H delay;

means for determining the intrinsic AR interval of the patients heart by;

sensing at least one P-wave associated with depolarization of an atrium through the atrial pace/sense electrodes as an atrial sensed event;

sensing at least one R-waves associated with depolarizations of a ventricle through the ventricular pace/sense electrodes as a ventricular sensed event; and

timing an intrinsic AR interval from at least one pair of successive atrial and ventricular sensed events; and

means for establishing the A-H delay as a function of the determined intrinsic AR interval;

wherein the means for establishing an A-H delay as a function of the determined intrinsic AR interval comprises means for setting the A-H delay to be shorter than the determined intrinsic AR interval.

5. An atrial-ventricular (AV) synchronous pacing system that comprises a dual chamber pacemaker pulse generator coupled with pacing leads extending to ventricular pace/sense electrodes disposed in operative relation to a ventricle, atrial pace/sense electrodes disposed in operative relation to an atrium, and His bundle pace electrodes disposed along the AV septum in operative relation to the bundle of His, the pulse generator further comprising:

means for establishig an atrial pacing escape interval;

means for timing out the atrial pacing escape interval;

means for sensing P-waves associated with depolarizations of the atrium through the atrial pace/sense electrodes as atrial sensed events;

means for restarting the atrial pacing escape interval on the sensing of an atrial sensed event within said atrial pacing escape interval;

means for delivering an atrial pace pulse through the atrial pace/sense electrodes to the atrium at the time out of the atrial pacing escape interval;

means for timing out an A-H delay from an atrial sensed event or delivery of an atrial pace pulse;

means for delivering a His bundle pacing pulse through the His bundle pace electrodes to the bundle of His upon time-out of the A-H delay;

means for determining the intrinsic AR interval of the patient'"'"'s heart by;

sensing at least one P-wave associated with depolarization of an atrium through the atrial pace/sense electrodes as an atrial sensed event;

sensing at least one R-waves associated with depolarizations of a ventricle through the ventricular pace/sense electrodes as a ventricular sensed event; and

timing an intrinsic AR interval from at least one pair of successive atrial and ventricular sensed events; and

means for establishing the A-H delay as a function of the determined intrinsic AR interval;

wherein the means for establishing an A-H delay as a function of the determined intrinsic AR interval comprises means for setting the A-H delay to be longer than the determined intrinsic AR interval.

6. A pacemaker configured to by-pass sino-atrial node dysfunction or heart block superior to a His bundle comprising:

an atrial electrode adapted to sense atrial electrical activity;

a His bundle electrode in contact with the His bundle and adapted to deliver stimulating pulses to the His bundle;

a ventricular electrode in contact with a ventricle of a heart and adapted to sense ventricular electrical activity and to deliver a stimulating pulse to the ventricle; and

a pulse generator coupled to the atrial electrode, the HIS bundle electrode and the ventricular electrode, the generator adapted to process sensed electrical activity and generate His stimulation pulses causing ventricular depolarization after the atrial electrical activity is sensed;

whereby a ventricular pulse is generated by the pulse generator and delivered to the ventricle if ventricular depolarization is not sensed by the ventricular electrode within a prescribed time from the sensed atrial electrical activity.

7. The pacemaker of claim 6, wherein the atrial electrode is further adapted to deliver stimulating pulses to the right atrium and the pulse generator is further adapted to generate the atrial electrical activity via the atrial electrode.